Direct Deposit Authorization - America First Credit …
Direct Deposit Authorization
Complete or edit this form and submit it to your employer (or to whomever will be making payments to you to start using Direct Deposit, or change an existing Direct Deposit arrangement. Please make sure that all your personal information is correct, and keep a copy for your records.
Personal Information
Member Name:
Social Security Number:
Street Address: Line 2: City: Home Phone Number:
State:
Employee Number:
(if Applicable)
Zip: Work Phone Number:
Account Information
My Credit Union is: Bank Routing Number:
Account Type: Savings
*12 Digit Direct Deposit Number (ACH):
Pay to the Order of
For
324377516
Harland Clarke
VOID
PO Box 9199 ? Ogden, UT 84409 800-999-3961 ?
746001234567
Date
Dollars
Routing Number *12 Digit Direct Deposit Number (ACH)
*Your 12- Digit ACH Direct Deposit Number (ACH) can be found by logging into online banking, clicking on Share Savings or Checking and unhiding the number.
Deposit Information
E ective: Immediately Beginning on:
Amount: Entire Net Pay
% of Net Pay
Specific dollar amount: $
.00
Authorization
To Employer/Payor Name:
I authorize the above Employer/Pay or to initiate credit entries and, if necessary, to initiate any debit entries and adjustments to correct any erroneous credit entries for Direct Deposit of above payroll/other amount to my above account at America First Credit Union, on a recurring basis until I notify you in writing that I revoke this authorization.
X
Date:
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