Massachusetts Direct Deposit Form 3

MA/RI
Employer Authorization
Direct Deposit Form
Company Name
Company Address
City, ST, Zip
Employee Name
Employee Address
City, ST, Zip
Employee/Payroll #
Telephone Number
-
-
I hereby authorize direct deposit to my account at Webster Bank, 145 Bank Street, Waterbury,
CT 06702.
Webster Bank Routing/Transit #
211370231
Webster Bank Account #
Webster Bank Account Type
Checking
Savings
Date:
Signature:
Please return this form and a voided check from your Webster Bank account, to your Payroll Department.