Direct Deposit Request Form - Capital One
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
Account Number: Routing Number: Account Type:
Checking
Bank Name: Capital One Deposit Amount:
Savings
(Percentage or dollar amount)
Deposit Account #2
Account Number: Routing Number: Account Type:
Checking
Bank Name: Savings
Deposit Amount:
(Percentage or dollar amount)
Deposit Account #3
Account Number: Routing Number: Account Type:
Checking
Bank Name: Savings
Deposit Amount:
(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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