Employer Direct Deposit Sign-Up Form

Save Time with Direct Deposit
It’s safe, simple and it saves time.
Employer Direct Deposit Sign-Up Form
Take this completed form to your employer’s payroll department to request direct deposit of your payroll check.
Why Direct Deposit?
Customer Name
It’s convenient and it saves time.
Address
• Your check’s automatically
deposited into your account.
• It eliminates a trip to the bank.
• Your money is available in your
account on payday.
City
• You’ll receive a paper voucher for
your records.
Zip Code
Please have my payroll check automatically deposited into the
following account:
It’s safe and secure.
• No more lost or misplaced checks.
• Confirm your deposit by phone or
online.
State
Checking Account Number
or
Savings/MIA/Money Market Account Number
Bank’s Routing Number
It’s simple... here’s how.
• Payroll Checks
Take this completed application
form to your employer’s payroll
department. Include a voided check
so your employer can confirm your
account and routing/transmit
numbers. And that’s it! Your
employer does the rest!
• Government Checks
Your Banker can sign you up today!
I authorize (name of business)
and my bank to automatically deposit my payroll check into my
account listed above (this includes my authorization to correct
entries made in error.) This authorization will remain in effect until
I give written notice to cancel it.
Customer Signature
Member FDIC
Date
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