DIRECT DEPOSIT FORM *RETURN TO PAYROLL*

Effective May 1, 2000, the State of Colorado Fiscal Rules (Rule 9-2) require that all employees be on the Direct Deposit
Payroll Program.

Please note: It is important that you fill out as much information as possible to prevent delays with your pay. Please
complete and return this form along with one (1) voided check or a copy of a Direct Deposit Authorization Form from your
bank to the PAYROLL DEPT.

****Please notify Payroll Services immediately, should you close or make any changes to your account(s). Direct
deposit(s) processed against a closed account can delay your pay up to 5 business days. ****

___ Enroll in Direct Deposit* ___ Replace Current Account* ___Additional Checking/Savings*
*Voided check or Bank Authorization form REQUIRED

___CANCEL existing Direct Deposit (Close Account)

Name:

CWID #:





Primary Account: [For remaining bal. if choose secondary account]

Savings:



Routing No

Checking:



Account No:

Bank Name:

Bank Phone No.
(if known)

Secondary Account: [Amount Specified]


Savings:



Routing No

Checking:



Account No:



Specific $ Amount:

Bank Name:

Bank Phone No.

(if known)

CSM Department: __________________________ CSM Extension or Contact No.:_________________

(Check one)
___Undergraduate ___Graduate ___ Classified ___Temp. Classified ___ Faculty___ Other

Signature: __________________________________
Date: ___________







Please TAPE your voided check here. DO NOT STAPLE

Document Outline