Iu Employee Reimbursements Authorization For Ach Credit Form printable pdf download

Iu Employee Reimbursements Authorization For Ach Credit Form

IU Foundation Form

IU Employee Reimbursement Authorization for ACH Credit

Name (Please print)_______________________________________________

Required E-Mail Address__________________________________________

⁮

I hereby authorize Indiana University Foundation to START

depositing reimbursements owed to me into my bank account as shown

below.

⁯

I hereby authorize Indiana University Foundation to STOP

depositing reimbursememens owed to me into my bank account as shown

below.

⁮

My banking information has changed; please change my account

information as shown below:

Name of Bank________________________________________________

City_______________________________ State______ Zip ___________

Type of Account:

Checking_____ Savings_____

Bank Account Number_______________________________________

Routing Number____________________________________________

(nine digits)

I certify that the information I provided is correct and that I am an authorized signer or designate

of the account provided for direct deposit transactions and am entitled to provide this

authorization. I hereby authorize Indiana University Foundation to initiate credit entries to the

account and financial institution listed above. I further authorize adjusting entries (reversals) to

correct errors, if any. This authorization is to remain in full force and effect until Indiana University

Foundation has received written notification from me of its termination in such time and manner

as to afford Indiana University Foundation and the depository financial institution a reasonable

opportunity to act on it.

I acknowledge that the origination of ACH transactions to my account must comply with the

provisions of U.S. Law. This authorization may be discontinued only by my written request.

Signature________________________________________________________________

Campus Phone___________________________Date__________________________________

*DO NOT ATTACH TO IUF CHECK REQUEST. Return form by Mail or Fax:

Mail to: IU Foundation, Accounts Payable, PO Box 500, Bloomington, IN 47402.

Fax: IU Foundation, Accounts Payable, 812-856-4384.

If you have any questions, please contact IUF Accounts Payable, 855-3144 or 855-6301.

Iu Employee Reimbursements Authorization For Ach Credit Form