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Bank Account

The document is a Non-Federal Direct Deposit Enrollment Request Form for Bank of America, allowing customers to authorize automatic deposits into their checking or savings accounts. It provides instructions for completing and submitting the form to the employer or company, along with necessary account details. The form also includes a section for the employer's information and customer authorization, ensuring compliance with U.S. law regarding ACH transactions.

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79 views1 page

Bank Account

The document is a Non-Federal Direct Deposit Enrollment Request Form for Bank of America, allowing customers to authorize automatic deposits into their checking or savings accounts. It provides instructions for completing and submitting the form to the employer or company, along with necessary account details. The form also includes a section for the employer's information and customer authorization, ensuring compliance with U.S. law regarding ACH transactions.

Uploaded by

harveyspecter.la
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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BANK OF AMERICA~~

BANK OF AMERICA, N.A. (THE "BANK")

Non-Federal Direct Deposit Enrollment Request Form


Authorization agreement for automatic deposits (ACH credits)

Directions for Customer Use:


1) Ensure entire form Is complete, then sign and date
• Use the ABA routing number from the state where your account was opened
2) Ensure appropriate Employer I Company address Is used when malling completed form
3) Employer I Company should review this form for completeness and suitability. If Employer /
Company prefers or requires their own form, use account type, number and ABA routing number below to
help complete their form
4) Mall form directly to Employer I Company (Note: It is not necessary for employer or company to return
the form to the bank once direct deposit is set up into the payroll system)

Employer / Company Name:

Employer Address City State Zip


I (we) authorize the above named Employer/ Company to initiate credit entries to my Bank of America Checking
and/or Savings accounts indicated below and to credit the same to such account. I (we) acknowledge that the
origination of the ACH transactions to my (our) account must comply with the provisions of U.S. law.
Note: Funds can be de oslted Into one account ors lit between accounts as a set ercent or dollar amount.
Account Type [!] CheckingD Savings State Acct Opened NJ
----
Account Number 3810 5966 1452
AS A Routing Number
--------
021200339
-------- -----
Deposit Amount
- - - - - -- -- - - - - - - - - - - - -
% OR$ (Flat Amount)

Account Type D Checking D Savings State Acct Opened


----
Account Number
ASA Routing Number
Deposit Amount % OR$ (Flat Amount) OR D Remaining
Account Type 0 Checking D Savings State Acct Opened
Account Number
ASA Routing Number
Deposit Amount % OR$ (Flat Amount) OR D Remaining
If_monies to which I am not entitled are deposited to my account I authorize the Em lo er / c ·
direct the fi~anc!al institution to retu~n said funds and I authorize' the financial instituiior{to act ~~~~~YE~s~e~/~
Co~pany d~rect,on ~nd ~o return said funds. This authority will remain in effect until Employer / Com an Ph y
received written not1ficat1on from me of its termination in such time and in such manner as to affo d ~ ~ as
Company and financial institution a reasonable opportunity to act on it. r mp oyer 1
BLEST TRUCKING LOGISTICS LLC
Name

54 GARDEN VIEW TER UNIT 13


EAST WINDSOR NJ 08520
Address
City/State/Zip

08/10/2022 856-503-6378
Signature (required)
Date Telephone Number

NOTE: Written credit authorization must 'd th .


· thprov1 the . at ~he receiver may revoke the authorization only by notifying
the originator in the manner specified 1
NNJ n e au onzat1on.

00-14-9291M 001 02-2014

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