Save Time with Direct Deposit

Complete this form, take it to your employer’s payroll department and get your paychecks deposited directly into your account.

Name

Address

City State ZIP code

Company name

Account # or Customer ID # Social Security number (XXX-XX-XXX) Company address City State ZIP code

I authorize (name of business) and my bank to automatically deposit my paycheck into my account listed above (this includes my authorization to correct entries made in error). This authorization will remain in effect until I give written notice to cancel it.

If you wish to set up or transfer direct deposit of income from investments, pension/retirement plans, interest or dividends, complete the below fields and mail it to your company. Account type: Checking Savings

Chase routing number

Chase account number

Customer signature Date

Member FDIC JPMorgan Chase & Co. 2018