Member Services
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Direct Deposit Enrollment Form
Account Information
Name:                                                 Tazara Stevens
Bank Name:                                            The Bancorp Bank
Address:                                              6100 S Old Village Pl, Sioux Falls, SD 57108
Routing Number:                                       031101279
Account Number:                                       156114104235
Amount
            Deposit my entire paycheck.                                             Deposit $                          dollars of                           Deposit                         % of my
                                                                                    my paycheck.                                                            paycheck.
Voided Check
                                The Bancorp Bank                                                                                                                             123
                                Tazara Stevens
                                                               VOID
                                8427 Alderpoint Terrace Nw,
                                Pickerington, OH 43147
                                PAY TO THE                                                                                                          $
                                ORDER OF
                                                                                                                                                  DOLLARS
                                FOR
                                A031101279 C156114104235 C123
                          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 Chime Account.
Authorization
I authorize                                                      (employer/payer) to initiate credit entries, and, if necessary to initiate any debit entries to
correct previous credit errors, to my Chime Spending Account. This authority will remain in effect until I notify my employer or
other payor in writing or as otherwise specified by my employer or payer.
   Signature                                                                                                Date
Banking Services provided by The Bancorp Bank, Member FDIC. The Chime Visa ® Debit Card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. and may be used everywhere Visa debit cards
are accepted. Direct deposit capability is subject to payer's support of this feature. Check with your payer to find out when the direct deposit of funds will start. Funds availability is subject to timing of payer’s
funding. The recipient’s name on any deposits received must match the name of the Chime Member. Any deposits received in a name other than the name registered to the Chime Spending Account will be
returned to the originator.