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Void Check Aug 18, 2023

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21 views1 page

Void Check Aug 18, 2023

Uploaded by

jasonbutt6669
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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e hZ &r t

BANK O F AMERICA~~
BANK OF AMERICA; N.A. (THE "BANK")

Non-Fe~eral Direct Deposit Enrollment Request ~orm


Au thorization agreement for automatic deposits (ACH credits)

Directions for Customer Use:


1)
Ensure entire form is complete, then sign and date

• Use th e ABA routing number from the state where your account was opened
2)
Ensure appropriate Employer I Company address is used when mailing completed form
3)
Employer I Company should review this form for completeness and suitability. If Employer~
Company prefers or requires their own form use account type number and ASA routing number elow to
help complete their form ' '

4) Mail form directly to Employer I Company (Note: It is not necessary for employer or company to return
the form to the bank once direct deposit is set up into the payroll system)

Employer / Company Name:

Employer Address City State Zip


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 transactions to my (our) account must comply with the provisions of U.S. law.
Note: Funds can be de oslted into one account ors lit between accounts as a set ercent or dollar amount.
Account Type 0 Checking O Savings State Acct Opened _T_X_ __
Account Number 4880 7657 2883
ABA Routing Number 111000025
Deposit Amount % OR$ (Flat Amount)

BEREKETBEYENEGEBEYEHU 1001
62 I 8 RIDGECREST RD APT I 123
DALLAS TX 752316779

Bank of America . . .
ACMM l I 1000025

,: I, ,0000 25 ,: ~880?1;.5? 2883 ,. ,oo,

If monies to which I am not entitled are deposited to my account, I authorize the Employer/ Company (issuer) to
direct the financial institution to return said funds and I authorize the financial institution to act on the Employer;
Company direction and to return said funds. This authority will remain in effect until Employer/ Company has
received written notification from me of its termination in such time and in such manner as to afford Employer;
Company and financial institution a reasonable opportunity to act on ii.

BEREKETBEYENEGEBEYEHU
Name

6218 RIDGECREST RD APT 1123 DALLAS TX 752316779


Address City/State/Zip

08/ 18/2023 214-769-2462


Signature (required) Date Telephone Number

NOTE: Written cred it authorizati~n must provide that ~he receiver may revoke the authorization only by notifying
the originator in the manner specified In the authorization.
NTX
00-14-929 1M 002 02-201 4

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