WLU Direct Deposit Form

WLU Direct Deposit Form - Refunds Only

Type of Enrollment

New Enrollment

Updated Banking Information

Updated Address

Name on Checking/Savings Account(Required)

Name of Student(Required)

Student ID Number(Required)

Last Four of Social Security #(Required)

Consent(Required)

To distribute my student refund as required from time to time by previous agreement, to the below Receiving Bank checking/savings account. This authority will remain in effect until I notify you in writing to cancel it in such time as to afford United Bank time to act on it.

I agree

Consent(Required)

I authorize West Liberty University and United Bank to initiate electronic credit entries, and if necessary, debit entries and adjustments for any credit entries in error to my checking or savings account as indicated below:

I agree

Type of Account (Select Only One)(Required)

Checking Account

Savings Account

Banking Information

Name of Bank

First

Address of Bank

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Routing Transit/ABA Number _ _ _ _ - _ _ _ _ - _(Required)

Account Number(Required)

Signature

Electronic Signature (Please type complete Name of Account Holder)(Required)

Date(Required)

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