Direct Deposit Authorization Form

Direct Deposit Authorization Form
TD Bank makes setting up direct deposit easy with this convenient, pre-filled form. There are two types of
direct deposit enrollment available: Federal Government Benefit Compensation and Payroll Compensation.
Steps to enroll for each are outlined below.
1. Federal Government Benefit Compensation:
To sign up for direct deposit of your federal benefit payments such as Social Security, SSI or VA Compensation and Pension Payment
• Go to the U.S. Department of the Treasury website: www.godirect.org, or
• Enroll by phone by calling the U. S. Department of the Treasury toll free at: 1-800-333-1795
You’ll need your:
• Social security number or claim number
• 12-digit federal benefit check number
• Amount of most recent federal benefit check
• TD Bank’s routing transit number:
• TD Bank account number:
• Type of account (checking or savings):
2. Payroll Compensation
Complete and sign this direct deposit form and give it to your employer’s payroll representative – it’s that easy!
Employee name and address:
Employee phone number:
Employee ID:
(if applicable)
Employee social security number:
Please begin directly depositing my payroll and/or dividend or annuity check into my account at TD Bank.
Direct deposit the following:
o Total net check amount
o The set amount of $_____________________________ of my net check each period.
Bank name:
TD Bank, N.A.
Address:
32 Chestnut St.
P.O. Box 1377
Lewiston, ME 04243-1377
TD Bank routing transit number:
TD Bank account number:
Type of account:
Employee signature
o Checking
o Savings
Date
11440C-CHK (03/16)