Travel Reimbursement
Direct Deposit Authorization

Department ________________________________________________

Campus Phone # ____________________________________________

[  ]  I would like to participate in the direct deposit service for travel expense reimbursements and hereby authorize the Procurement Office to access my direct deposit authorization information on file in the Payroll Office so that reimbursement can be made to the same account(s). 

Bank Name: ________________________________________________

Type of Account:  Checking / Savings  (please circle one)

(please indicate which account you would like your travel reimbursement deposited to)

[  ] I would like my Travel Expense Reimbursements to be deposited into the following account which is not on file with the Payroll Office.

Name as it appears on the Account: _____________________________

Account # __________________   Bank Routing # _________________

Your personnel number can be located on your payroll check stub in the “Employee ID” box.

Date ________________    Signature _____________________________