Direct Deposit Switch Form

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DIRECT DEPOSIT
SWIT H FORM
New Direct Deposit Request
Change Direct Deposit Request
YOUR INFORMATION
Name
Address
State
Zip
City
Telephone (Day)
Social Security No.
(Only required if you are changing a social security direct deposit)
TYPE OF DIRECT DEPOSIT
Payroll
Social Security
Other
(Please Specify)
Effective immediately, I hereby authorize _______________ to make all of my direct
deposits to the following Spencer Savings Bank account:
Routing Number: 221271951
Account Number: _____________________
Type Of Account:
Checking
Savings
Deposit Amount:
Net Pay
Fixed Amount - $___________
Thank you for your assistance with this matter.
Sincerely,
_______________________________________
______________
Account Holder Signature
Date
S
S
B
PENCER
AVINGS
ANK
Big bank services. Small bank friendly.
Fill out one Switch Form for each direct deposit that you would like switched to Spencer. Additional forms can be picked
up at your local branch. Include a copy of a voided Spencer check along with this request. Requests to change Social Se-
curity direct deposits can either be dropped off at your branch, mailed to your local Social Security office, or changed over
the phone by calling (800) 772-1213.

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