Direct Deposit Enrollment Direct Deposit Enrollment
New Request Change Request New Request Change Request
Use this form to notify your employer (or any other non-governmental organization Use this form to notify your employer (or any other non-governmental organization
that regularly sends a payment to you) that you want the proceeds deposited directly that regularly sends a payment to you) that you want the proceeds deposited directly
into the PNC Bank accounts specified below. into the PNC Bank accounts specified below.
Name Social Security Number Name Social Security Number
WI
Address Address
City, State, ZIP Code City, State, ZIP Code
I hereby authorize (company/organization name) ______________________________, I hereby authorize (company/organization name) ______________________________,
hereinafter called “ORIGINATOR”, to initiate credit entries and to initiate, if necessary, hereinafter called “ORIGINATOR”, to initiate credit entries and to initiate, if necessary,
debit entries and adjustments for any credit error to my account(s) indicated below debit entries and adjustments for any credit error to my account(s) indicated below
and the depository institution named below, hereinafter called “DEPOSITORY”, to and the depository institution named below, hereinafter called “DEPOSITORY”, to
credit and/or debit the same to such account. credit and/or debit the same to such account.
Primary Account Primary Account
Depository Name (Bank) Account Type Depository Name (Bank) Account Type
PNC Bank Checking Savings PNC Bank Checking Savings
Acct No. ______________________________ Acct No. ______________________________
Routing Number Amount to Deposit Routing Number Amount to Deposit
Net Pay $ ____________________ Net Pay $ ____________________
(fixed amount) (fixed amount)
If the ORIGINATOR allows direct deposit to more than one account, I elect to have part If the ORIGINATOR allows direct deposit to more than one account, I elect to have part
of my proceeds put into the following account: of my proceeds put into the following account:
Optional Secondary Account Optional Secondary Account
Depository Name (Bank) Account Type Depository Name (Bank) Account Type
PNC Bank Checking Savings PNC Bank Checking Savings
Acct No. ______________________________ Acct No. ______________________________
Routing Number Amount to Deposit Routing Number Amount to Deposit
Net Pay $ ____________________ Net Pay $ ____________________
(fixed amount) (fixed amount)
This authority is to remain in full force and effect until ORIGINATOR has received This authority is to remain in full force and effect until ORIGINATOR has received
written notification from me of its termination in such time and in such manner as written notification from me of its termination in such time and in such manner as
to afford ORIGINATOR and DEPOSITORY a reasonable opportunity to act on it. to afford ORIGINATOR and DEPOSITORY a reasonable opportunity to act on it.
Date Signature Date Signature
Direct Deposit... Direct Deposit...
as easy as... as easy as...
1 1
The quickest way to sign up for direct deposit – or The quickest way to sign up for direct deposit – or
change it – is to ask your employer for their direct change it – is to ask your employer for their direct
deposit form, then fill it out using your new account deposit form, then fill it out using your new account
number and routing number (see illustration below). You number and routing number (see illustration below). You
may be able to use this form for any non-governmental may be able to use this form for any non-governmental
2 2
organization, but check with your employer first. organization, but check with your employer first.
You can even use this form to have dividend or You can even use this form to have dividend or
insurance payments directly deposited to your insurance payments directly deposited to your
account. account.
3 3
No more wondering if the check will No more wondering if the check will
get to you on time or whether you’ll get to you on time or whether you’ll
have time to get to the bank. With have time to get to the bank. With
Direct Deposit, it’s conveniently and Direct Deposit, it’s conveniently and
automatically done for you. automatically done for you.
Sample Routing Number Sample Routing Number
Sample Account Number Sample Account Number
FORM118021-0406 FORM118021-0406
