Employee Direct Deposit Request

NAME:

BRANCH:

Complete the required information. Allow at least 2-3 weeks for processing. For checking accounts, a copy of a voided check must be provided. For savings accounts, a copy of a deposit slip must be provided.

DIRECT DEPOSIT 1
NAME OF BANK:

ABA#:

ACCOUNT#:

CHECKING

SAVINGS

I would like to deposit:

Entire Net Pay

(OPTIONAL_Add 2nd Account if necessary

DIRECT DEPOSIT 2

NAME OF BANK:

ABA#:				ACCOUNT#:
CHECKING				SAVINGS

I would like to deposit:

Entire Net Pay

ATTACH A COPY OF A VOIDED CHECK / SAVINGS DEPOSIT SLIP:

Order for this direct deposit authorization to be valid, the name of the employee must be on the voided check or deposit slip. A notice from the bank authorizing the employee to deposit funds into the account will be accepted.

I hereby authorize my employer to deposit any amounts owed me by initiating credit entries to my account at the financial institution(s) listed above. Further, I authorize the financial institution(s) listed above to accept and to credit any entries indicated by CCF to my account. In the event that CCF deposits funds erroneously into my account, I authorize CCF to debit my account not to exceed the original amount of the erroneous credit.

This authorization is to remain in full force and effect until CCF has received written notice from me of its termination in such time and in such manner as to afford CCF a reasonable amount of time to act on it.

Employee Signature

Date:

Employee Direct Deposit Request

ATTACH A COPY OF A VOIDED CHECK / SAVINGS DEPOSIT SLIP:

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