Direct Deposit Enrollment/Paycard Election Form

Direct Deposit Enrollment/PayCard Election Form

As a convenience to faculty, staff, and student staff members, and to promote sustainability and cost-effectiveness, Puget Sound makes payroll, expense reimbursement, and certain other payments by direct deposit to banking/credit union (financial) institutions that are members of the Automated Clearing House (ACH), or to a “PayCard” issued by the university’s bank.

Please choose between Direct Deposit andPayCard below and complete, sign, and return this form to the Payroll Officein Howarth Hall Room 016. If you elect the PayCard option, please include a completed and signed Wells Fargo PayCard Sign-up Form. We welcome your questions.Contact us at253.879.3416; on campus extension 3416;or .

I would like to receive a PayCard. Please complete the Wells Fargo PayCard Sign-up Form.
I would like Direct Deposit to my account(s) listed below. For each account listed, attach a voided check or a form from your financial institution listing the routing number and account number (online accounts).
Primary Account*Financial Institution:
Routing Number: / All*/Balance of my check
Account Number: / Check one: / Checking / Savings
*non-payroll payments will be deposited into the Primary Account in full.
Additional Accounts: To deposit a portion of your payroll payment to another account, complete the following section.
Financial Institution:
Routing Number: / Exact Amount: / $
Account Number: / Check one: / Checking / Savings
Financial Institution:
Routing Number: / Exact Amount: / $
Account Number: / Check one: / Checking / Savings
Direct Deposit Authorization and Acceptance
Please read, complete, and sign this section if you chose Direct Deposit above.
I authorize The University of Puget Sound (“Puget Sound”) to initiate electronic credit entries (direct deposit) and if necessary, adjustments (debit entries) for any direct deposit amounts in error, to the financial institution account(s) identified above. I agree not to hold Puget Sound responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. This agreement will remain in effect untilI submit a new electronic payment authorization form to the Payroll Office or the Payroll Office has received written notification from me of its termination in such time as to afford a reasonable opportunity to act. This agreement may end at the discretion of Puget Sound.
Print Name: / Check one: Faculty/Staff Student
UPS ID (if known): / Contact Phone:() -
Signature: / Date:

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