The University of Akron Office of the Associate Vice President/Controller Accounts Payable ACH Deposit Vendor Authorization Please complete form and return to the Accounts Payable department with a cancelled check which identifies both your account number and the depository’s (financial institution) nine-digit transit routing number Return Completed Form and copy of Cancelled Check to: The University of Akron, Accounts Payable, OR Fax to AP: 330-972-5702 302 Buchtel Common, Akron, OH 44325-6214 The University of Akron will deposit payments directly into your bank account and send an e-mail notification of the deposit so that you know when the money is available to you Contact Accounts Payable with any questions at (330) 972-7200 Section 1: Depository Information Please Select One: NEW Direct Deposit Depository (Bank) Name: Transit Routing Number: Account: Check only one: Checking CHANGE Direct Deposit CANCEL Direct Deposit Savings TRANSIT ROUTING NUMBER: This is the identification number of your financial institution/Depository This is normally located in the lower left hand corner of your check or deposit ticket Also, you may call your financial institution and request their number YOUR ACCOUNT NUMBER: This is your checking or savings account number at your financial institution/depository Be sure to indicate if the account number is for checking or a savings account (check only one box) Section 2: Vendor Information Business name: Address: (Street, City, State, Zip): Contact person: Office phone number: E-mail address for notification: (E-mail address is mandatory for this service) Section 3: Authorization I hereby authorize THE UNIVERSITY OF AKRON and the DEPOSITORY named above to initiate direct deposit entries and to initiate, if necessary, reversal entries to adjust for any deposit entries made in error to my account This authority is to remain in full force and effect until THE UNIVERSITY OF AKRON has received written notification from me of its termination in such time and in such manner as to afford THE UNIVERSITY OF AKRON and DEPOSITORY a reasonable opportunity to act on it I understand THE UNIVERSITY OF AKRON maintains the right to terminate, suspend, or amend the ACH Deposit program in whole or in part at any time Chief Financial Officer Signature: PRINT NAME Accounts Payable Use ONLY Manager Approval: CAP-6-04[A] 12/06 Date: Vendor ID: Originated From: CAP-6-04[A] 12/06 Date Entered: Purchasing Email Entered by: Fax Campus Mail U.S Mail