Illinois Institute of Technology AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT OF PAY
Illinois Institute of Technology 36-2170136

I hereby authorize Illinois Institute of Technology, hereinafter called IIT: to initiate credit entries; to initiate, if necessary, debit entries and adjustments for any credit entries in error to my account as indicated below and the depository named below, hereinafter called DEPOSITORY; to credit and / or debit the same to such an account.

Please indicate: New account Change account information  
  OLD account is closed.   Print checks until Direct Deposit is established.
ACCOUNT #1 INFORMATION
Type of Account:   Checking (Attach voided check) Savings (Attach bank-provided documentation)
DEPOSITORY NAME BRANCH
CITY ST      ZIP  
TRANSIT / ABA NUMBER
(9 digits)		 ACCOUNT NO.
ACCOUNT #2 INFORMATION
Type of Account:   Checking (Attach voided check) Savings (Attach bank-provided documentation)
DEPOSITORY NAME BRANCH
CITY ST      ZIP  
TRANSIT / ABA NUMBER
(9 digits)		 ACCOUNT NO.
AMOUNT TO BE DEPOSITED INTO: ACCT #1:   ACCT #2: Remainder, if Acct 1 is not 100%.
  (Percentage or Dollar amount or 100%)    

All new bank account changes/additions must have bank-issued documentation (i.e. voided check, bank-provided form showing account information) in order for direct deposit information to be processed. Savings account deposit tickets are not acceptable.

This authority is to remain in full force and effect until I complete and submit to IIT a new authorization form indicating my intent to change the account into which my pay is to be deposited, or until my employment at IIT terminates.

SOCIAL SECURITY NO. NAME  
   
DATE SIGNATURE Phone

Please notify the Payroll Department if this account information changes. This form must be printed and signed in order to be processed. You may fax this form to Payroll at 312-567-3420. Contact payroll@iit.edu with any questions.