Michigan Direct Deposit Form 2

» Direc t Deposit Authorization Form
Use this form to instruct your employer to redirect your payroll deposits into your new Flagstar Bank account.
Step 1: Complete, sign and date this form.
Step 2: Attach one of your new personal checks from Flagstar Bank with the word ‘Void’ in large letters on the front of the check. DO NOT SIGN THE CHECK.
Step 3: Submit this form to your employer or payroll department for processing.
I wish to deposit into my Flagstar Bank: (check only one)
q Entire Net Pay
q
% of Net Pay
q Specific Amount $
Account Information: (check only one)
q Checking Account
q Money Market Savings Account
Account Number:
Banking Center Address: 301 West Michigan Avenue
City: Jackson
State: Michigan
Zip Code: 49201
Flagstar Bank Routing Number: 272471852
I authorize
(Employer/Originator of Funds) to initiate credit entries and, if necessary, to initiate
debit entries to correct any errors made with respect to a credit entry to my Flagstar Bank Account.
Signature:
Date:
/
/
Authorization is valid only to initiate direct deposit of funds into a Flagstar Bank account. Participation in direct deposit is dependent on the ability of your
employer/originator of funds to offer such a service and your ability to meet your employer/originator of funds eligibility requirements.
Some organizations (e.g. Social Security) require specialized forms to be completed for direct deposit. To be certain, contact your employer/originator
of funds to make certain all applicable forms are completed.
flagstar.com
Member FDIC
Rev 8/12