Oficial Use Oty Oklahoma State University AUTOMATIC DEPOSIT TRANSMITTAL This Soro beused by Sale and Fighar Education Employees incommumaating th Goo depos iormaton Social Security| ——~SCS*~*S*S*d~Cé Beth F ‘Number: | Maonnry First Name [=p teat ar a fcecces Sey {ite 1S emesis). |_| Sedna Ce {hereby authorize the State of Oktahoma, as per the Oklahoma State Employee's Direct Deposit Act 74:202.10 to Fee PAYROLL —(Depoct my payral waranlia my account as ileatad Pslew EMOVE PAYROLL = undelsand Wal by tarninating Dveot Depoat for Payrou is wil aMoralcally TInSTs WOVE and Lo ‘spending from my direct deposit) monies to which 1 em nol entitled are deposited to my account 1 aulhorize the State of Oklahoma to direct the financial insitution to ‘otumn Said funds. | understand the payroll date and frequency of payment curently boing ullized by my employing agency will nol be affected by my decision to use Electronic Fund Transter. ONLY ONE ACCOUNT MAY BE USED FOR DIRECT perosir [4 crecninc =] savincs [] PayCara Financial instution | = Name (voursen | (DEWUSTALG Panic : state: | iby: ‘This authomty is to remain ip Tull force and effect unait (A) | give my employer writen notes using this farm (OPM-73} to terminate this dicoct dopostt agreement. (B) | ail to utiize payroll divest depusit for 265 days, al which time this agreement wil expire. (C) The event of my death, at which time this agreement expires immediately, upon notification. This information is provided by me t9 facitate my Personal banking neade and shall be contidered pursanal and held in confidence. ame 1316 Wie foe iy: ~SHuwaten seen [Oe | ap: | ota Home Telephone Work Telepnone [SY ‘Number: “3 ‘Number | emai Empeying Agener: | = Signatu DDL eee Agi owe: 6 trp! 279 lage 6 xcteet inn precan ay, ae oe RS acids te IF this isan fetal enrolment cr hank routing anllor account number change pleace attach a veiged eheek cr an effets! document trom Your financial insituton showing the fnancial mettuton's reuling number and your account number. acknowledge that! have received and understand A signed form must be on file with he empioyet “The foes associated with the PAYCARD, Name Dats understand that while 3 Piease mail the completed form fo the address. below ATTENTION: Oklahoma State University Payroll Services 409 Whitehurst ‘Stithwater, OK 74078 406-744-6972