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Direct Deposit Authorization
Authorization for Electronic Funds Transfer
This form authorizes the depositor to initiate electronic fund transfers to the account holder's designated bank account.
S
E
C
T
I
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N
A
Account Holder Information
1Full Name
2Email Address (optional)
3Street Address
4City
5State
6ZIP Code
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N
B
Bank Account Information
7Name of Financial Institution
8Account Type
Checking    Savings    Money Market
9Bank Address
10Routing Number (9 digits)
11Account Number
S
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C
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C
Depositor & Authorization
12Depositor Name (employer, agency, or organization)
The account holder authorizes the above-named depositor to initiate direct deposit (credit) entries, and corrective adjustments for any credit entries made in error, to the account indicated above. This authorization remains in effect until the depositor receives notice of revocation in sufficient time to act.
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Certification & Signature
By signing below, the account holder certifies that the information provided above is accurate and complete and authorizes the electronic funds transfers described in Section C.
13Signature
14Printed Name
15Date
2026-04-05
Direct Deposit AuthorizationContains Personally Identifiable InformationPage 1 of 1

What is a direct deposit authorization form?

A direct deposit authorization form is a written statement that authorizes an organization — your employer, a government agency, a pension fund, or any other paying entity — to deposit funds electronically into your bank account. Instead of receiving a paper check, payments arrive automatically.

The form includes your personal details, your bank's routing number, your account number, and your signed authorization — putting your intent to receive electronic payments in writing.

Some organizations also ask for a voided check alongside this form to verify your routing and account numbers. You can generate one on our voided check page.

When do you need one?

  • Starting a new job and setting up payroll

  • Switching banks or opening a new account

  • Government benefits (Social Security, VA, tax refunds)

  • Pension or retirement benefit deposits

  • Freelance, contractor, or commission payments

  • Insurance claim or settlement payouts

  • Scholarship or financial aid disbursement

  • Changing from paper checks to electronic deposit

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