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Direct Deposit Enrollment Form: Account Information

Gerald Smith is providing his bank account information to set up direct deposit with his employer. The form includes his name, the bank name and routing number, and his account number. A voided check is also included to verify the account details. Gerald authorizes his employer to directly deposit his pay into the provided checking account.

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GERALD
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1K views1 page

Direct Deposit Enrollment Form: Account Information

Gerald Smith is providing his bank account information to set up direct deposit with his employer. The form includes his name, the bank name and routing number, and his account number. A voided check is also included to verify the account details. Gerald authorizes his employer to directly deposit his pay into the provided checking account.

Uploaded by

GERALD
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
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Direct Deposit Enrollment Form

Account Information
Account holder’s name Bank Name Routing Number Account Number
Gerald Smith Choice Financial Group 091302966 260105490023

Voided Check

Choice Financial Group


Gerald Smith 1234
3153 CHULIO RD SE
DATE
ROME GA, 30161
PAY TO THE
$

VOID
ORDER OF

DOLLARS

MEMO

a 091302966 a 260105490023 d 1234


The image of this voided check may be provided to your employer or other payer for no other purpose except to set up
direct deposit to your Lili Account.

Authorization
I authorize ______________(payer) to directly deposit my pay to the checking account listed above, and, if
necessary correct entries made in error. I understand that this authorization replaces any previous authorization and
will remain in effect until I modify or cancel it in writing.

Signature Date

Banking Account Services provided by Choice Financial Group, Member FDIC. Direct deposit capability is subject to payer’s support of this
feature. Confirm with your payer to find out when the direct deposit of funds will start. Funds availability is subject to timing of your payer’s
funding. The recipient’s name on any deposits received must match the name of the Lili Account holder. Any deposits received in a name
other than the name registered to the Lili Account holder will be returned to the originator.

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