UNIVERSITY OF CALIFORNIA, SANTA BARBARA …

                   UNIVERSITY OF CALIFORNIA, SANTA BARBARA

                                   GAUCHO DIRECT DEPOSIT
                                             Authorization Form
                          (Questions? Go to http://www.barc.ucsb.edu/Billing/refunds.htm )
        New

        Change

I hereby authorize the University of California, Santa Barbara to (1) deposit my refund check via electronic
transfer of funds, and (2) my financial institution to credit funds to my checking account. This authorization
will remain in effect until cancelled in writing.

Name:                                                                   PERM #:

Phone No.:                                           Email Address:

Signature:

Date:

Account Number:

Routing/Transit Number:

Bank Name:

Branch Address:

Branch City:                                                 State:                          ZIP:

                                * * * ATTACH VOIDED CHECK HERE * * *




                                       Mail or deliver this completed form to:
                                         BARC Systems & Operations
                                     University of California Santa Barbara
                                                 1212 SAASB
                                       Santa Barbara, CA 93106-2003
                                          http://www.barc.ucsb.edu/
                                                (805) 893-3756
                                             FAX (805) 893-8063