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CONTACTS | FORMS & INFORMATION | LINKS | MEMOS | TRAINING & MANUALS

VENDOR PAYMENT DIRECT DEPOSIT AUTHORIZATION FORM

INSTRUCTIONS: Please complete this form, print out, and attach a voided check.
MAILTO: Accounting Services and Controls, UCSB
ATTN: Bernice Yost
3201 SAASB
Santa Barbara, CA 93106-2040

New request Account change Cancellation

Vendor Information

Company Name:		Taxpayer ID NUmber:
Contact Name/ Company Representative:		Daytime Phone Number:
Email Address for Company Representative:
Providing Goods/Services to:
Campus Department:	Campus Contact:	Extension:

Banking information

Financial institution:		Branch:
Address:
City:	State:	Zip:
Account Type: Checking Savings
Account Number:	Transit Routing Number (ABA):
Where can I find the Account Number and Transit Routing Number (ABA)?
I hereby authorize: (1) the University of California to deposit payments for goods/services via electronic transfer of funds, and (2) my financial institution to credit the payment to our company’s account. This authorization will remain in effect until canceled in writing.
X Company Representative Signature	Phone:	Date:

ATTACH VOIDED CHECK IN THIS AREA

Please Note:

Each account is prenoted (verified) with the bank. This process takes approximately 10 days.
Do not write checks against the account until you receive a remittance advice.
If you change banks or accounts within your bank, please complete another Vendor Payment Direct Deposit Authorization Form as soon as possible.
Please verify your account number and transit routing number with your Financial Institution.
If you close your account, please contact (805) 893-4288 in Accounting as soon as possible.

SEE PRIVACY NOTIFICATION

Accounting use only

APEX ID

Bank code

Date

Prenote

STATE PRIVACY NOTIFICATION
The State of California Information Practices Act of 1977 (effective July 1, 1978) requires the University to provide the following information to individuals who are asked to supply information about themselves: The principle purpose for requesting information on this form is to acquire authorization for disbursements of employee reimbursements directly to a financial institution of the individual's choosing. University policy authorizes the maintenance of this information. Furnishing all information on this form is mandatory. Failure to provide such information will delay or may even prevent completion of the action for which the form is being filed. Individuals have the right to view their own records in accordance with Staff Personnel Policy 605 and Academic Personnel Policy 160. The office responsible for maintenance of the information on this form is Accounting Services and Controls.

For further questions or comments, please email
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