EASTERN KENTUCKY UNIVERSITY
ELECTRONIC FUNDS TRANSFER AGREEMENT


I request and authorize Eastern Kentucky University Payroll Office, and its designated processing facility, to make electronic deposits and adjustments to my designated account. This authority is to remain in full force and effect until EKU has received written notification from me to terminate this agreement and in such time to afford EKU reasonable opportunity to act on it.

DEPOSITOR'S NAME (Type or Print Legibly)
CITY/STATE EKU ID Number
CHECK ONE:  
 Initial Setup        Request Paycard
Changing Financial Institution

 Account Number Change Only
 Additional Savings Account

Financial Institution One: Financial Institution Two:



Checking 
            Savings

Dollar Amount to Deposit: $  or

Percent of Net to Deposit: %



Checking            Savings

Dollar Amount to Deposit: $  or

Percent of Net to Deposit: %

 (Use additional forms for more accounts)


**PLEASE READ CAREFULLY:  IN THE EVENT A CREDIT IS MADE TO MY ACCOUNT IN ERROR, MY SIGNATURE AUTHORIZES EKU AND ITS DESIGNATED BANK TO MAKE A CORRECTING ENTRY AS NECESSARY.
            
Authorizing Signature                                                                      Date

FOR HUMAN RESOURCES USE ONLY - (FINANCIAL INSTITUTION MICR INFORMATION)
Prenote Date   Deposit Date  
Financial Institution One Financial Institution Two

Account Number

ABA Number

Account Number

ABA Number


***Please Attach Documentation from Financial Institution indicating the "Routing Number & Your Personal Account Number"***
(deposit slips are not acceptable in most cases!!)
ACH Requirements:
After Payroll receives this form, the next available pay period will be a prenote - no $$$ deposit
(the financial institution verifies account # prior to actual dollar deposit)
The following pay period your specified dollar amount will deposit into your new account!!