Vendor ACH Direct Deposit Authorization Form

Vendor ACH Direct Deposit

Authorization Form

Company (or individual) Legal Name (please print)

___________________________________________

Salt Lake Community College and the financial institution shown on this form are authorized to

deposit directly to the account noted on this form and, if necessary, adjust any SLCC deposit entries

made in error. This authority will remain in effect until a new authorization form is submitted or this

authorization is rescinded in writing.

Name of Financial Institution Branch Phone Number (optional)

_______________________________ __________________________

Email Address (to receive notification of

deposit)

__________________________

Authorizing Signature _________________________________ Date _____________

Name & Title of Authorized Signer

Please e-mail, mail, or fax this form to: Salt Lake Community College

Attn: Accounts Payable

PO Box 30808

Salt Lake City, UT 84130-0808

Fax #: 801-997-4770

Bank

Routing #:

Account

Office Use

S-___________________