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ACH Keller direct deposit authorization form

ACH Keller direct deposit authorization form - DSI...

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STUDENT DIRECT DEPOSIT ENROLLMENT/ AUTHORIZATION AGREEMENT New Enrollment Stop Authorization Change in Bank and/or Account Information I hereby authorize DeVry, Inc. to activate, change, or cancel direct deposit, per my selection above, with the named financial institution for the account number specified. This authorization will remain in effect until cancelled in writing. A new authorization must be completed if I change my account or change financial institutions. I understand that a deposit to my account does not necessarily mean that I have a $0 balance on my account. (Please print or type)
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Unformatted text preview: DSI: D03228693 Full Name: Jonathan I. Sullivan E-mail address: [email protected] Account Information Type of Account: Checking Name of Financial Institution: Bank of America ABA or Bank Routing Number (Checking only): 063100277 Bank Account Number: 005500788474 Student Signature: __________________________________ Date: _______________ To submit completed form: Fax to: (888) 513-8669 Questions and information contact Student Finance Office at 866-533-3879 X...
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