Wisconsin Direct Deposit Form 3 - Free Download
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Wisconsin Direct Deposit Form 3
Wisconsin Direct Deposit Form 3
University of Wisconsin Service Center Human Resource System
Authorization for Direct Deposit of Payroll
The University of Wisconsin System distributes pay using an electronic direct deposit program.
Select One: Biweekly Payroll (Classified/LTE/Student/Unclassified Hourly appointments)
Monthly Payroll (Faculty, Academic Staff, Teaching and Research Assistant appointments)
Effective Date: As Soon As Possible
Future Pay Date: _______________
Employee Information | Please Print
Name (Last, First, MI): _____________________________________________________
Payroll Empl ID OR
Social Security Number (Last 4 Digits Only): ________________________
Phone Number: ______________________________________ Email Address:
__________________________________________________________________
Primary Account |
This is where your entire paycheck or the balance is deposited after the
%
or
$
amount is deducted from the second and third accounts listed below.
Select one:
Start
Change
Account Type
(Select one):
Checking
Savings
ABA Transit Routing Number:
Account Number:
_______________________________________________________________
Name of Financial Institution: ______________________________________________________
Financial Institution City, State:
____________________________________________________
NET PAY
Second Account | Optional
Select one:
Start
Change
Cancel
Account Type
(Select one):
Checking
Savings
ABA Transit Routing Number:
Account Number:
_______________________________________________________________
Name of Financial Institution: ______________________________________________________
Financial Institution City, State:
____________________________________________________
%
or
$
Third Account | Optional
Select one:
Start
Change
Cancel
Account Type
(Select one):
Checking
Savings
ABA Transit Routing Number:
Account Number:
_______________________________________________________________
Name of Financial Institution: ______________________________________________________
Financial Institution City, State:
____________________________________________________
%
or
$
Check this box if the entire amount of your direct deposit is ultimately deposited to a financial institution outside of the United States.
Read statement carefully: I authorize the University of Wisconsin to direct deposit funds to my account in the financial institution listed above. If funds to which I am
not entitled are deposited in my account, I authorize the University to initiate a correcting (debit) entry. I understand that the authorization may be rejected or
discontinued by the University at any time. If any of the above information changes, I will promptly complete a new authorization agreement. If the direct deposit is not
stopped before closing an account, funds payable to you will be returned to the University for distribution. This will delay your check.
Employee Signature: _______________________________________________________________________ Date: ___________________________ (mm/dd/yyyy)
P1032.201012 Additional information is on the reverse side.
mm/dd/yyyy
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