North Carolina A&T State University
Direct Deposit Authorization

New Enrollment [     ]        Change Enrollment [     ]     Delete Enrollment [     ]

Student Name (Please Print)_________________________________________________

Bank Name______________________________________________________________

Student ID #_________________________ Student Phone #_______________________

Instructions:
COMPLETE ALL THE INFORMATION ABOVE; ATTACH A VOID CHECK TO THIS FORM, THEN SIGN AND DATE AT THE BOTTOM OF THE PAGE.

NOTE:  A void check that bears the bank routing number and account number, must be attached with the submission of this authorization agreement.  Your name and address must be preprinted on the check. We will not accept starter or counter checks.
Please make certain to write VOID across the face of the check.

Please Read the Following Carefully:

Once your consent for direct deposit has been processed, a one-time zero dollar ($0.00) transaction may be processed and may appear on your bank statement.  This is a test transaction to ensure the accuracy of the electronic deposit information. This process can take up to ten (10) business days. No direct deposit of refunds can occur during this period. Once you sign up for direct deposit, all future refunds will be in the form of direct deposit unless this agreement is terminated by written notification.

Your signature on this consent form authorizes the University to apply financial aid funds to the balance of your student account including miscellaneous charges, charges left unpaid from previous semesters and returned check charges. Proceeds from any financial aid award will be deposited into your checking account. If the funds are electronically deposited into your checking account in error, the University reserves the right to initiate a debit transaction against your account to recoup the funds. 

The information provided on this form will continue to be in effect during your enrollment at the University.  This information will be used for subsequent semester refunds unless you submit a new authorization form to change or cancel this direct deposit enrollment. Cancellations must be in writing to the Treasurer’s Office.

It is your responsibility to notify the Treasurer’s Office of any change in your bank account. Any changes that have occurred without our notification will cause a delay in the disbursement of your refund. The University will not initiate any refunds while awaiting the return of funds caused by a rejected direct deposit.  Additionally, you may incur a $10.00 charge for the return of funds caused by a rejected direct deposit. 

Please note that it is your responsibility to make certain that your refund has been deposited into your account prior to conducting any transactions that would draw against those funds.

Student Signature:_____________________________________ Date______________