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    Direct Deposits

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    ken frost
    This document is a non-federal direct deposit enrollment form. It provides instructions for completing the form, including ensuring it is fully filled out and signed. It also lists the required account information for direct deposit including the account type, deposit amount, account and routing numbers. The form authorizes the employer to make direct ACH deposits into the designated bank account.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Direct Deposits

    Uploaded by

    ken frost
    573 views1 page
    This document is a non-federal direct deposit enrollment form. It provides instructions for completing the form, including ensuring it is fully filled out and signed. It also lists the required account information for direct deposit including the account type, deposit amount, account and routing numbers. The form authorizes the employer to make direct ACH deposits into the designated bank account.

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    This document is a non-federal direct deposit enrollment form. It provides instructions for completing the form, including ensuring it is fully filled out and signed. It also lists the required account information for direct deposit including the account type, deposit amount, account and routing numbers. The form authorizes the employer to make direct ACH deposits into the designated bank account.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    573 views1 page

    Direct Deposits

    Uploaded by

    ken frost
    This document is a non-federal direct deposit enrollment form. It provides instructions for completing the form, including ensuring it is fully filled out and signed. It also lists the required account information for direct deposit including the account type, deposit amount, account and routing numbers. The form authorizes the employer to make direct ACH deposits into the designated bank account.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Non-Federal Direct Deposit Enrollment Request Form

    Authorization agreement for automatic deposits (ACH)

    Please follow these directions

    1. Ensure the entire form is complete. If printing, sign and date it.

    2. If providing this form directly to your Employer, they should review this form for completeness
    and suitability. If Employer / Company prefers or requires their own form, use the account type,
    number and ABA routing number below to complete their form.

    3. Enter the account information on the form into your employers Human Resources Payroll portal
    or provide it to your employer.

    Employer or Company name: Goodwrx


    Account type: MYAC
    Deposit amount: 100%
    Account Number: 501026620125
    State where opened: NV
    ABA routing number: 122400724

    1001
    KENDELL PIERCE
    711 E NELSON AVE APT 3029
    ____________
    NORTH LAS VEGAS, NV 89030-1817 Date
    Pay To The
    Order Of _____________________________________________________________________________ $ _____________________

    VOID
    _____________________________________________________________________________________ Dollars

    For _____________________________________ ________________________________________________________

    :122400724: 501026620125 1001

    I (we) authorize the above named Employer / Company to initiate credit entries to my Bank of
    America checking and / or Savings accounts indicated below and to credit the same to such
    account. I (we) acknowledge that the origination of the ACH transaction to my (our) account must
    comply with the provision of U.S. law.

    Customer name: _______________________


    Signature: _______________________
    Date: _______________________

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