Vendor ACH/Direct Deposit Authorization

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Name
Vendor/Payee Information
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Contact Person Contact Person First Last
Phone Phone - ### - ### ####
Email
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Would you like to receive receipts via email? Yes No
Financial Institution Information
Bank Name
Bank Address Bank Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Name on Bank Account
Account Number
Nine-digit Bank Routing Number (ABA)
Account Type

Account Type Checking Savings
Approvals/Authorizations

I certify that the information provided on this form is correct, and I hereby authorize Christian Brothers University to electronically deposit payments to the bank account designated above . It is my responsibility to notify accountspayable@cbu.edu immediately if I believe there is a discrepancy between the amount deposited to my bank account and the amount of the invoice paid. I understand that I must notify accountspayable@cbu.edu immediately of any changes in status or banking information. I understand that this authorization will remain in full force and effect until accountspayable@cbu.edu has received written notification requesting a change or cancellation and has had reasonable opportunity to act on it, which should take no longer than seven to ten business days.
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Date Date / MM / DD YYYY

Vendor ACH/Direct Deposit Authorization

Vendor ACH/Direct Deposit Authorization

Vendor/Payee Information

Financial Institution Information

Approvals/Authorizations