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Direct Deposit: Sample Check

The document is a Direct Deposit Authorization form that needs to be completed and submitted to the respective company for payroll or government deposits. It requires personal information, banking details, and options for new or existing authorizations. The form also includes a section for signatures from both the employee and employer, along with instructions for submission.

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sophialucy962
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25 views1 page

Direct Deposit: Sample Check

The document is a Direct Deposit Authorization form that needs to be completed and submitted to the respective company for payroll or government deposits. It requires personal information, banking details, and options for new or existing authorizations. The form also includes a section for signatures from both the employee and employer, along with instructions for submission.

Uploaded by

sophialucy962
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

Authorization

Complete this Send the direct deposit authorization form to the company* making the direct deposit. For
your payroll direct deposit, please give this form to your Human Resources department. If you
have Social Security or other governmental direct deposit, please go to any Fifth Third
form for each
Banking Center, and they can set you up.

company with
LAST NAME FIRST NAME

which you have STREET ADDRESS CITY STATE ZIP

WORK PHONE HOME PHONE


direct deposit.
SOCIAL SECURITY NUMBER

EMPLOYER’S NAME PHONE NUMBER EMPLOYEE ID NUMBER OR DEPARTMENT

1 FIFTH THIRD ACCOUNT NUMBER


CHECKING SAVINGS $
ROUTING & TRANSIT NUMBER. TYPE OF ACCOUNT AMOUNT OF DIRECT DEPOSIT

2 FIFTH THIRD ACCOUNT NUMBER


CHECKING SAVINGS $
ROUTING & TRANSIT NUMBER. TYPE OF ACCOUNT AMOUNT OF DIRECT DEPOSIT

Check Only One:


A NEW AUTHORIZATION FOR DIRECT DEPOSIT. PLEASE CHANGE MY EXISTING AUTHORIZATION.
NOT CURRENTLY USING DIRECT DEPOSIT. TRANSFER AUTOMATIC PAYMENT FROM MY PREVIOUS
BANK TO FIFTH THIRD BANK.

EMPLOYEE SIGNATURE DATE

EMPLOYER SIGNATURE DATE

S t a p l e Vo i d e d F i f t h T h i r d C h e c k B e l o w :

Sample Check 0001

DATE

PAY TO THE ORDER OF

Routing Number Account Number


MEMO

:123456789 : 0123456789 0001

* You should use one form for each company. Please make additional copies as needed.
Fifth Third and Fifth Third Bank are registered service marks of Fifth Third Bancorp. Member FDIC.
Equal Housing Lender.

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