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Sharonview FCU Direct Deposit Form

This document is a pay selection authorization form for direct deposit. It instructs the employee to provide their name, SSN, contact number and store number. It asks them to check the box to receive pay through direct deposit and select checking or savings. Fields are included to fill in the financial institution routing number, account number, amount and to re-enter for verification. The employee signs and dates digitally to authorize direct deposit of their pay.

Uploaded by

Keiriyon Lockhart
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
178 views2 pages

Sharonview FCU Direct Deposit Form

This document is a pay selection authorization form for direct deposit. It instructs the employee to provide their name, SSN, contact number and store number. It asks them to check the box to receive pay through direct deposit and select checking or savings. Fields are included to fill in the financial institution routing number, account number, amount and to re-enter for verification. The employee signs and dates digitally to authorize direct deposit of their pay.

Uploaded by

Keiriyon Lockhart
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Pay Selection Authorization

Agreement
JBD

is proud to offer one option for receiving your pay: Direct Deposit. Pleas

box for your selection below, and fill out all required fields in that section.

To authorize direct deposit, please follow these instructions


1.
2.
3.
4.

Provide your name and Social Security Number in the spaces below.
Check the box indicating where you want your pay deposited checking or savings.
Complete the financial institution information for your account.
Electronically Sign and date the form.

Full Name: Mykel S Lockhart

SSN: 654030570

Contact Number: 8432748370

Store Number: 1901

Option 1 - I wish to be paid through Direct Deposit

Amount to deposit: Ne
Account 1 Type:

Checking Savings

Amount: 200
Routing Number:

Account Number: 157222

253075303

Re-Enter Routing Numb


Re-Enter Account Number: 157222

253075303

Bank Name:
sharonview federal credit union

Digitally Signed By: Mykel Lockhart


Date: Mar-14-2016 [Link] PM EDT

Employee Signature

03/14/2016
Date

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