Student Electronic Transfer Form

Student Electronic Transfer Form
By signing the form below, you are authorizing USSU to directly deposit your STUDENT REFUNDS into the account listed below.
Please print.
Name:
Student ID:
Authorizing Signature:
Date:

MonthDayYear
Date
Type of Account
We accept the following:

VOIDED CHECK or BANK DOCUMENT

Supporting document must include student name, account number & routing number

(Student name must be on account for direct deposit)
UPLOAD A PICTURE OR SCAN OF A VOIDED CHECK OR BANK DOCUMENT

Cancelof
If you do not have the documents mentioned above, complete information below:
Routing Number:
Account Number:
IF YOU HAVE ANY QUESTIONS PLEASE CONTACT YOUR USSU FINANCIAL AID COUNSELOR: financialaid@ussu.edu
Should be Empty: