The University of North Carolina at Chapel Hill
Direct Payroll Deposit Authorization

I authorize my employer, The University of North Carolina at Chapel Hill, to deposit my net payroll earnings to my bank account as named below.

Please print or type.
 
1. Bank or Credit Union Name  2a. City

 

 2b. State
3. Employee Name 4. Account Type (check one)

ÿChecking  ÿ Savings
5. Employee SSN  6. Bank or Credit Union Transit No.

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 7. Bank or Credit Union Account No. 
8. I am paid on the (check one):  ÿ Biweekly Payroll ÿ Monthly Payroll
9. This is a (check one):  ÿ  New Authorization  ÿ  Change in Bank or Account

10. This authorization will remain in effect until I give written notification to UNC-CH Payroll Services to cancel it. A minimum of thirty (30) days must be allowed for processing a cancellation or change. I understand that, should I terminate University employment, my final paycheck will not be deposited to my bank account but will be forwarded to my department.
 
 
_______________________ ____________________________
Date  Employee Signature

11. Attach a copy of your pre-printed bank or credit union deposit slip or voided check in the box below.
 
Instructions to Complete Form
  1. Enter the name of the bank or credit union where you have your account.
  2. Enter the city and state where you have your bank or credit union account.
  3. Enter your name as it appears on your paycheck.
  4. Indicate the type of bank or credit union account that will receive the direct deposit.
  5. Enter your social security number as it appears on your social security card.
  6. Enter the 9-digit bank transit number that appears in the lower left-hand part of your deposit slip or check.
  7. Enter you bank or credit union account number which is located after the bank transit number.
  8. Indicate on which payroll you are paid.
  9. Indicate if this is a new authorization or change in authorization.
  10. Read the statement, sign, and date the form.
  11. Attach a copy of your pre-printed bank or credit union deposit slip or voided check in this box.

 
FOR PAYROLL SERVICES USE ONLY
Employee SSN
Effective Date
Transit No. 6097
6098
Account No. 6099

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