Fillable Direct Deposit Authorization Form printable pdf download

Direct Deposit Authorization Form

To: __________________________________________________________________________________

(Company Name/Employer)

I authorize you to electronically deposit my pay as directed to my account(s) listed below:

NOTE: Funds can be deposited into one account or split between accounts as a set percent or dollar amount.

Checking

Savings

ACCOUNT TYPE:

(Attach a voided M&T Bank Check or pre-printed Savings Withdrawal Ticket to help ensure accuracy)

Account Number: _________________________

ABA/Routing Number: ___________________________

(first 9 digits located at the bottom left corner of your checks or withdrawal tickets)

Deposit Amount: __________% OR

$__________ (flat amount) OR

Remaining

Checking

Savings

ACCOUNT TYPE:

(Attach a voided M&T Bank Check or pre-printed Savings Withdrawal Ticket to help ensure accuracy)

Account Number: _________________________

ABA/Routing Number: ___________________________

(first 9 digits located at the bottom left corner of your checks or withdrawal tickets)

Deposit Amount: __________% OR

$__________ (flat amount) OR

Remaining

Checking

Savings

ACCOUNT TYPE:

(Attach a voided M&T Bank Check or pre-printed Savings Withdrawal Ticket to help ensure accuracy)

Account Number: _________________________

ABA/Routing Number: ___________________________

(first 9 digits located at the bottom left corner of your checks or withdrawal tickets)

Deposit Amount: __________% OR

$__________ (flat amount) OR

Remaining

Please use the following personal information and signature as authorization, or to contact me with

any questions.

Name

___________________________________________________________________

(First/Middle/Last):

Street Address: _________________________________________________________________________

City: ___________________________________ State: ___________ Zip Code: ___________________

Social Security Number

: _________________________________________________

(If required by employer)

Daytime Phone Number: __________________ Employee Number

: ___________________

(If applicable)

Signature

______________________________________________ Date: __________________

(Required):

When you have completed this form, submit it to your employer’s payroll department.

Contact your employer or income source to make sure no other special forms are required.

M&T Bank Routing Numbers:

022000046 – New York, New Jersey and Connecticut

031302955 – Pennsylvania and Delaware

052000113 – Maryland, Virginia, West Virginia and DC

Member FDIC. CS11739 (1/16)

Direct Deposit Authorization Form

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