The University of Montana Business Services 32 Campus Drive Missoula MT 59812 Phone: (406) 243-6260
FAX: (406) 243-4929
Direct Deposit Application and Authorization for Accounts Payable
Instructions:   Complete all information. Mail or deliver this form to Attn. Accounts Payable at the address above.
Today's Date:      New Application    Change    Cancel
                                                                       Employee    Student    Other
Name:
Banner Vendor ID (If Known) or Tax Identification Number (TIN/SSN):
Address:
City:   State:   Zip:  
Email:      Phone:   
Checking    Savings
                                           *See Below

Bank Routing Number (must be nine digits long):

Bank Account Number:

Sample Check
**IMPORTANT** - If selecting Savings, you must also complete the State of Montana's 1199A form and include your financial institution's certification of the routing number and account number. The form can be found on the State of Montana's website using the following link: http://hr.mt.gov/Payroll/Direct%20Deposit%20Form.pdf
I authorize the University of Montana to deposit my payments or reimbursements check(s) directly to my savings or checking account. It is my responsibility to notify Accounts Payable at 406-243-2516 immediately if I become aware of any changes in status or banking information or if there is a discrepancy between the amount deposited and the payment amount.

Signature:___________________________________________________________


IF YOU ARE USING A CHECKING ACCOUNT, PLEASE SECURELY ATTACH A VOIDED CHECK TO THIS FORM. (This check must be imprinted by bank with your name/address)
**The bank routing number may be different for electronic deposits than it is for manual deposits (the number shown on your deposit slip).  If you are using any account type other than a checking account, please verify the correct electronic routing number by calling your financial institution.    Print this form
---------------------------------------------- Business Services Internal Use Only ------------------------------------------------

PP SEQ:                                              E-Mail Address Verified:                                              Setup Complete: