Direct Deposit enrollment form

1 9 41 _ R _ I H A _ 8 -1 5 - 2 1 Direct Deposit enrollment formCompany/Employer NameEmployee nameEmployee IDSignatureDateTo enroll in Direct Deposit , simply fi ll out this form and give it to your employer. Some employers require a voided check to be authorize the above named Company/Employer to initiate credit entries to the account(s) indicated below, and to credit the same to such account. I acknowledge that the origination of ACH transaction to my account must comply with the provisions of informationPrimary Direct Deposit accountIf no additional accounts are specifi ed, 100% of your net pay to Truist will be deposited into the Primary additional Direct Deposit accountsDistributions are made to accounts according to the priority specifi ed.

2 Accounts with the lowest priority numbers are funded fi rst, with the balance of your pay deposited into your Primary monies to which I am not entitled are deposited to my account, I authorize my Company/Employer to Direct the fi nancial institution to return said authorization is to remain in full force and eff ect until the Company/Employer has received written notifi cation from me of its termination in such manner as to aff ord Company/Employer and Truist Bank a reasonable opportunity to numberPriorityBank nameTransit routing numberMust be nine digitsAccount numberAmount(Check one)

3 999 Truist Bank$ Checking SavingsPriorityBank nameTransit routing numberMust be nine digitsAccount numberAmount(Check one)1 Truist Bank$ Checking Savings2 Truist Bank$ Checking SavingsRouting number