Direct Deposit Form

In order to expedite your payment, please fill out the direct deposit form. After completing the form, be sure to review all of your account information.

Name (First & Last)

Last 4 of SSN

Consultant Engagement or Employee ID #

Employee ID# can be found in Ultipro (FOR STAFF ONLY)

Consultant ID# can be found on the agreement you signed.

Bank Name (full name)

Bank Routing Number

Bank Account Number

Account Type

Checking

Savings

Copy of voided check or bank notice

Drop your files here

Acknowledgment (check box below)

I authorize WestEd to deposit funds into my account as indicated above. If funds to which I am not entitled are deposited into my account, I authorize WestEd to direct the financial institution to return said funds. This authorization agreement for Direct Deposit is to remain in effect until WestEd has received written notification from me of its termination in such time and such manner to afford WestEd and the Financial Institution a reasonable opportunity to act on it. lt is my responsibility to inform WestEd of any bank or account changes.

Date

mm/dd/yyyy

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