ContractDirect Deposit Authorization Agreement • February 3rd, 2016
Contract Type FiledFebruary 3rd, 2016Northeast Ohio Medical University Direct Deposit Authorization Agreement New Authorization Change in existing authorization STUDENT INFORMATION Legal Name (Last, First, Middle Initial) Student ID Number (if applicable) Current Address: (Street) (City) (State) (Zip Code) Telephone Number email address I hereby authorize Northeast Ohio Medical University and the DEPOSITORY named below, to initiate direct deposit entries and to initiate, if necessary, reversal entries to adjust for any deposit entries made in error to my account also indicated below. This authorization is to remain in full force and effective until NEOMED has received written notification from me of its termination, or in such time and in such manner as to afford NEOMED and DEPOSITORY a reasonable opportunity to act on it. I further understand NEOMED maintains the right to terminate, suspend or amend the Direct Deposit program in whole or in part at any time. When signing up for this method of rec