Human Resources Financial Center

Direct Deposit Authorization

Complete this form for each company you want to

set up with direct deposit.

Send this direct deposit authorization form to the company* that’s making the direct deposit for you. For payroll direct deposit, please give this form to the human resources department. If you have Social Security or other governmental direct deposit, please go to any Fifth Third Financial Center, and a banker can get you started. Last Name First Name

Street Address City State Zip

Work Phone Home Phone

Social Security Number

Employer’s Name Phone Number Employee ID Number or Department Account #1:

Fifth Third Account Number Routing and Transit Number Checking Account Savings Account Amount of Direct Deposit

$

Account #2:

Fifth Third Account Number Routing and Transit Number Checking Account Savings Account Amount of Direct Deposit

$

Check only one:

A New Authorization for Direct Deposit.

Not Currently Using Direct Deposit.

Please Change my Existing Authorization.

Transfer Automatic Payment from my Previous

Bank to Fifth Third Bank.

Employee Signature Date

Employer Signature Date

(cont.)

June 2020

Fifth Third and Fifth Third Bank are registered service marks of Fifth Third Bancorp. Fifth Third Bank, National Association. Member FDIC. Equal Housing Lender. 1

Direct Deposit Information

1001

Pay to

Account Type:

Routing Number

Fifth Third Bank, National Association. Member FDIC. Equal Housing Lender. Fifth Third and Fifth Third Bank are registered service marks of Fifth Third Bancorp.

Account Number

To set up direct deposit with your employer you will need to refer to the information provided below. Please print or download this document. Memo

Date

1001

VOID

LIDN

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