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    Direct Deposit Enrollment Form: Account Information

    Uploaded by

    GERALD
    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.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Direct Deposit Enrollment Form: Account Information

    Uploaded by

    GERALD
    460 views1 page
    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.

    Original Title

    Direct Deposit Form

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    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.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    460 views1 page

    Direct Deposit Enrollment Form: Account Information

    Uploaded by

    GERALD
    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.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Customer Support

    1 (855) 545-4380
    [email protected]

    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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