ࡱ> MOL 27bjbjR|R| *@00v ff,lRlf|@XZZZZZZ$g #T~Qhhh~   h"X hX    E D0 m#6m# m# 8; t _;;;~~6;;;hhhhm#;;;;;;;;;f :  NICHOLLS STATE UNIVERSITY DIRECT DEPOSIT ENROLLMENT AUTHORIZATION EMPLOYEE NAME EMPLOYEE ID #  FORMTEXT      DEPARTMENT/OFFICE OR AGENCY  FORMTEXT      ACTION TYPE ( check one)  FORMCHECKBOX  NEW  FORMCHECKBOX  CHANGE  FORMCHECKBOX  TERMINATE THIS OPTION EFFECTIVE DATE  BANK ACCOUNT NUMBER 1 FINANCIAL INSTITUION NAME  FORMTEXT      FINANCIAL INSTITUTION ROUTING (ABA) NUMBER  FORMTEXT      BANK ACCOUNT NUMBER  FORMTEXT      ACCOUNT TYPE (check one)  FORMCHECKBOX  *CHECKING (Provide voided check for account verification )  FORMCHECKBOX  *SAVINGS (Provide copy of savings account card)AMOUNT OF DEPOSIT (check one) _______ Total Net Pay _______ Flat Dollar Amount $_________________ BANK ACCOUNT NUMBER 2 FINANCIAL INSTITUTION NAME  FORMTEXT      FINANCIAL INSTITUTION ROUTING (ABA) NUMBER  FORMTEXT      BANK ACCOUNT NUMBER  FORMTEXT      ACCOUNT TYPE (check one)  FORMCHECKBOX  *CHECKING (Provide voided check for account verification )  FORMCHECKBOX  *SAVINGS (Provide copy of savings account card)AMOUNT OF DEPOSIT (check one) _______Balance of Net Pay _______ Flat Dollar Amount $_________________ I _______________________________________authorize and request Ӱɴý to direct my net pay check to the account at the financial institution I have designated above. I understand that I will receive an actual paycheck after submitting this request in order for bank information to be submitted for pre-authorization. For any funds paid to me which are not due and owing to me, I hereby agree and authorize my appointing authority (employer) to adjust the amount next due to me to correct the overpayment, or to recover amount overpaid by reducing my future payroll checks so that the overpayment will be repaid or recouped in accordance with university policy. < . 0 2 F H V    8 : V X Z z | ٶ٩Ùٓ|objch6 CJUjh6 CJUj{h6 CJUjh6 CJU h6 CJjh6 CJUmHnHujth6 CJUjh6 CJUjh6 CJU h[D[CJ h7Z^CJ h6 CJ h6 CJ\h6 5CJ\ h6 5CJ h6 CJh6 &<0 X d$If[$$If $p^p`a$$a$4$&$d%d&d'd+D./NOPQa$ $Ifrkd$$IfT 0pS'_04 aT & Z \ p r t ~  ( * , @ B D N P R T B F H d f h ػطػطػطwjh6 CJUj h6 CJUjh6 CJUjh6 CJU h[D[CJ h6 CJh6 jh6 CJUmHnHujh6 CJUjh6 CJU h6 5CJ h6 CJ h6 CJjh6 CJU. $ & Z {q d$If[$$If$da$ukd$$IfT40pR'` 04 af4T  * R d$If[$$Ifbkd$$IfT4p'B(04 af4TR T @ B ~ BDF$Ifukds$$IfT4&0pQ'a04 af4T  "$&0246"%&456Hz|ԷԷԠԷvj h6 CJUjh6 CJU h6 CJj h6 CJUh6 jh6 CJU h[D[CJjh6 CJUmHnHujh6 CJUjh6 CJU h6 5CJh6 5CJ\ hCJ h6 CJ h6 CJ. 4wwqg d$If[$$If$da$ $ 0pa$ukd$$IfT40pQ'a04 af4T46 d$If[$$Ifbkd$$IfT4)p'B(04 af4T"#Byz.$Ifukd $$IfT4&0pQ'a04 af4T|}-/0000000022@3z3|33333333333333344J444T5X5l5»ܱܤܻܱ܇ܻ܁{ h6 CJ h6 CJjx h6 CJUjh6 CJUmHnHuj h6 CJUjh6 CJU h6 >*CJ h6 CJ hCJU hCJ h6 CJ h6 CJj h6 CJU h6 CJjh6 CJU0./0xA99$da$7kd $$Ifl4*+64 laf4 $d$Ifa$$a$ukd $$IfT40pQ'a04 af4T22B3z3334 $d$Ifa$ $da$gd$da$It is my responsibility to notify Nicholls State University, as appropriate, should any changes occur to account(s) specified. Considering all above conditions are met, this authorization remains in full effect until a written, signed notification to terminate is received from me and Nicholls State University has had reasonable opportunity to act on the termination.   FORMTEXT        FORMTEXT        Signature Date Phone where you can be reached between 8:00 and 4:30 TO BE COMPLETED BY PAYROLL DEPARTMENT: MAIN BANK  FORMTEXT      FINANCIAL INSTITUTION ROUTING (ABA) NO. (If not provided above)  FORMTEXT      DEPARTMENT NUMBER  FORMTEXT      PERSONNEL NUMBER  FORMTEXT      EFT VALIDITY DATE  FORMTEXT      6/2013 4445V5X5XLC>9d]$a$$ "a$ $ "a$kd $$Iflr *, 2 |064 laX5l556<6>6d66666"7^kd$$IfT40s'  &4 af4p &T d$If[$$If l5n55555566*6,6.686:6d6f6z6|6~6666666666667777 7$70727 h[D[CJjxh6 CJUjh6 CJUjh6 CJUjh6 CJUjh6 CJUmHnHuj h6 CJU h6 CJjh6 CJU%"7$727$ 0a$akd$$IfT4 Fs'      4 af4T(/ =!"#h$h% tDText1tDText2$$If!vh#v#v_:V  055_44 TtDeCheck1tDeCheck2tDCheck3$$If!vh#v#v` :V 4055` / / 44 f4TtDText4$$If!vh#vB(:V 405B(44 f4TtDText4tDText4$$If!vh#v#va:V 4&055a44 f4TtDeCheck4tDeCheck5$$If!vh#v#va:V 4055a/ 44 f4TtDText3$$If!vh#vB(:V 4)05B(44 f4TtDText4tDText5$$If!vh#v#va:V 4&055a44 f4TtDeCheck4tDeCheck5$$If!vh#v#va:V 4055a/ / 44 f4TH$$If!vh#v+:V l465+4f4vDText19vDText20$$If!vh#v,#v #v2 #v#v|:V l065,5 52 55|/ / / / / / / / 4vDText13vDText14$$If!vh#v#v:V 4  &55/ 44 f4p &TvDText15vDText16vDText17r$$If!vh#v#v :V 4 55 / 44 f4T^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH D`D NormalCJOJQJ_HmH sH tH F@F  Heading 1$$@&a$ 56\]X@X  Heading 2$$$d@&^`a$5CJD@D  Heading 3$$@&a$ 5CJ\DA D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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