Campbell University
Authorization for Automatic Payroll Deposits / ACH Credits
______________________________________________________________________________
Employee Name (Please Print)
Social Security Number or Campbell ID #
Bank Name / Financial Institution__________________________________________________
Bank Contact Information ________________________________________________________
(City, State, Phone Number)
______________________________________________________________________________
Bank Routing/Transit/ABA Number
Bank Account Number
( ) Checking Account
OR
( ) Savings Account
Amount To Be Deposited Into This Account:
( ) Full Amount
( ) Specific Amount $____________
( ) Remainder
(after specific amount)
Each employee is required to participate in direct deposit.
I hereby authorize Campbell University, Inc. to initiate credit entries or debit corrections to the
account(s) indicated and the financial institution named to credit the same to such account.
This authority is to remain in full force and effect until Campbell University, Inc. has received
written notification from me of its termination in such time and such manner as to afford
Campbell University, Inc. a reasonable opportunity to act on it.
______________________________________________________________________________
Employee Signature
Date
Please attach a voided check to this form and send the completed form to:
Campbell University
Human Resources Office
PO Box 595 / 95 Bolton Road
Buies Creek, NC 27506
(910) 893-1699