391201c Direct Deposit Authorization Form v4

1 Direct Deposit Authorization form How to switch your Direct To: Payroll department Deposit (s) to bank : Subject: Direct Deposit 1. F. or payroll checks . Contact your company's From:_____. Human Resources department Date:_____. for instructions on updating your Direct Deposit account information . This memo serves as notification that I have established a new checking 2. For Social Security checks or savings account with bank . Attached you will find a voided Contact your local Social check from my new account. Security Administrative office. Listed below are the relevant account and routing numbers needed If your company does not have for you to establish payroll Direct Deposit to my new account. a process in place for updating your Direct Deposit account 1. U..S. bank routing number:_____. information , please follow these (The first set of numbers found on the bottom of your check).

2 Steps: 2. U..S. bank account number:_____. 1. Complete this form. (The second set of numbers found on the bottom of your check). 2. A. ttach a new bank check Check one: checking account savings account to the completed form and write VOID across the front. Do not Print name:_____. sign the check. 3. Submit to your employer. Employee Social Security number:_____. Follow-up on the switch: If this form is not sufficient to authorize and complete the Direct Deposit 1. C. all your company's Human update, please forward the authorized form for my signature. Resources department to check Signature:_____. on the progress of your request. Date:_____. 2. L. ogin to bank Phone number:_____. online banking to verify your Direct deposits are being deposited correctly. (Optional information ). Remember, it can take several If you have questions, please contact:_____.

3 Payroll cycles for changes to take effect! bank branch information :_____. Branch phone number:_____. Email:_____. Member FDIC. 2020 bank 391201c 8/20.