Accounts Payable Division of Financial Affairs Last updated: of ACH Authorization Form (Direct deposit for vendors, employees, students, alumni, or former employees) Part II: Bank Information Part I: Payee Information Name E-mail for Remittance Street Address City State Zip Code Phone Authorized Signature Date Account Type Corporate Checking Personal Checking* Personal Savings Corporate Savings I authorize Cornell University to deposit funds into the above-named bank account. I understand that it is my responsibility to verify that the funds are in my account before I make a withdrawal. Change Deposit Action: Bank Name Bank Routing Number (9-digits) Bank Account Number Part III: Authorization Complete this form to request non-payroll direct deposit of vendor or other payments to the bank account you specify below. ACH accounts will be set up for existing payee ID types. Please sign the form and fax it to the number specified at the bottom of the form. For Office Use Only Vendor Number KFS Vendor Name *If you select personal checking, you must submit this form along with a copy of a voided check for the bank account specified above. In lieu of a voided check, you may send an account and routing verification from the bank. You may submit this information by fax or postal mail. For Employees, Students, Alumni and Retirees Unit/Department Name Employee or Student ID NetID Fax this completed form to (607) 255-0866. Mailing address: Accounts Payable, Division of Financial Affairs Cornell University 341 Pine Tree Road, Ithaca, NY 14850 For assistance, contact Accounts Payable at (607) 255-6240 or [email protected] Vendor Number Alumnus/a Student Former Employee/Retiree Employee Affiliation

Accounts Payable ACH Authorization Form - Cornell … · Accounts Payable. Division of Financial Affairs of Last updated: ACH Authorization Form (Direct deposit for vendors, employees,

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Accounts Payable

Division of Financial Affairs Last updated: of

ACH Authorization Form (Direct deposit for vendors, employees, students, alumni, or former employees)

Part II: Bank Information

Part I: Payee InformationName

E-mail for Remittance

Street Address

City State Zip Code

Phone

Authorized Signature

Date

Account Type Corporate Checking Personal Checking* Personal SavingsCorporate Savings

I authorize Cornell University to deposit funds into the above-named bank account. I understand that it is my responsibility to verify that the funds are in my account before I make a withdrawal.

Change Deposit Action:

Bank Name

Bank Routing Number (9-digits) Bank Account Number

Part III: Authorization

Complete this form to request non-payroll direct deposit of vendor or other payments to the bank account you specify below. ACH accounts will be set up for existing payee ID types. Please sign the form and fax it to the number specified at the bottom of the form.

For Office Use OnlyVendor Number KFS Vendor Name

*If you select personal checking, you must submit this form along with a copy of a voided check for the bank account specified above. In lieu of a voided check, you may send an account and routing verification from the bank. You may submit this information by fax or postal mail.

For Employees, Students, Alumni and Retirees

Unit/Department Name

Employee or Student ID NetID

Fax this completed form to (607) 255-0866. Mailing address: Accounts Payable, Division of Financial Affairs Cornell University 341 Pine Tree Road, Ithaca, NY 14850 For assistance, contact Accounts Payable at (607) 255-6240 or [email protected]

Vendor Number

Alumnus/aStudentFormer Employee/RetireeEmployeeAffiliation

mailto:[email protected]