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Direct Deposit Form

The document provides a form for direct deposit that allows a user to provide up to three bank accounts and routing numbers to their employer to deposit funds into. It includes fields for account numbers, routing numbers, account types, deposit amounts or percentages, and requires the user's signature.

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0% found this document useful (0 votes)

346 views1 page

Direct Deposit Form

Uploaded by

goldenretriever854

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

Complete this form and give it to your employer / payer.

If they prefer to use their own form, you can use this as a reference.

Deposit Account #1 Bank Name: Capital One

Account Number: Deposit Amount:

Routing Number:

Account Type: Checking Savings (Percentage or dollar amount)

Deposit Account #2 Bank Name:

Account Number: Deposit Amount:

Routing Number:

Account Type: Checking Savings (Percentage or dollar amount)

Deposit Account #3 Bank Name:

Account Number: Deposit Amount:

Routing Number:

Account Type: Checking Savings (Percentage or dollar amount)

I authorize _______________________________ (company name) to initiate deposits and, if necessary,

withdrawals to correct erroneous deposit entries to my account(s) listed above. I understand that this
authorization replaces any previous authorization, and will remain in eﬀect until the company named
above has received written notiﬁcation from me of its termination in a reasonable enough time to act.

Name: ____________________________

Signature: ____________________________

Date: ____________________________

© 2018 Capital One. Capital One is a federally registered service mark. All rights reserved. Capital One and Capital One's family
of companies, including Capital One Bank (USA), N.A., and Capital One, N.A., Members FDIC.

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Direct Deposit Form

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Direct Deposit Form

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Direct Deposit

Complete this form and give it to your employer / payer.

Deposit Account #1 Bank Name: Capital One

Account Number: Deposit Amount:

Account Type: Checking Savings (Percentage or dollar amount)

Deposit Account #2 Bank Name:

Account Number: Deposit Amount:

Account Type: Checking Savings (Percentage or dollar amount)

Deposit Account #3 Bank Name:

Account Number: Deposit Amount:

Account Type: Checking Savings (Percentage or dollar amount)

I authorize _______________________________ (company name) to initiate deposits and, if necessary,

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