Michigan Direct Deposit Form 3 - Free Download
4.1, 3520 votes
Please vote for this template if it helps you.
Michigan Direct Deposit Form 3
Michigan Direct Deposit Form 3
Rev. 1/2012
Michigan State University
Direct Deposit Form
I (we) authorize Michigan State University to deposit excess Student Account or Fellowship stipend funds to the
account at the institution indicated below and to initiate a withdrawal from the account to adjust for deposit entries
made in error. I understand that if I change banks it is my responsibility to update my banking information. I also
understand in order to process my direct deposit, MSU will exchange key banking information including social
security number through a secure electronic transmission.
I will not transfer the entire amount of my direct deposit from a United States financial institution to a financial
institution in another country or to a foreign financial institution that has a branch office in the United States prior to
contacting the Student Billing and Receivables Office.
Please note a Change in Account: New Account for:
Last Name _____________________________________________
First Name _____________________________________________
Student PID ____________________________________________
Phone Number __________________________________________
Email __________________________________________________
Account Type ___________________________________________
Bank Name _____________________________________________
Bank Routing Number _____________________________________
Bank Account Number _____________________________________
Account Holder's Name ____________________________________
Account Holders SS# ______________________________________
This authority is to remain in full force and effect until MSU receives written notification from the
student or account holder or the account is inactive for one year. PLEASE ATTACH A VOIDED
Student Signature/Date
Account Holder’s Signature/Date
Student Billing & Receivables
DD Program
Michigan State University
Hannah Administration Building
426 Auditorium Rd Rm 140
East Lansing, MI 48824
Michigan Direct Deposit Form 3 Previous Page
Michigan Direct Deposit Form 3