Fillable Consumer Direct Deposit Authorization Quick Swith Kit Personal V5.indd (Bangor Savings Bank)

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Consumer Direct Deposit Authorization Quick Swith Kit Personal V5.indd (Bangor Savings Bank)

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Country of origin: US
File type: PDF

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DEPOSITOR INFORMATION
NAME OF COMPANY/ORGANIZATION PHONE
ADDRESS
CITY STATE ZIP
This serves as notification of a change in my direct
deposit information. Effective immediately, you are
authorized to establish direct deposit into my
B
angor Savings Bank account.
Step One
Direct Deposit Authorization
If you have any questions,
we will gladly talk you through it.
1.877.Bangor1
RECIPIENT INFORMATION
NAME
ADDRESS
CITY STATE ZIP
SOCIAL SECURITY NUMBER PHONE
BANK ACCOUNT INFORMATION
Bangor Savings Bank Routing Number: 211274382
Bank Account Number: ___________________________________________________________
❒
Checking
❒
Savings
AUTHORIZATION
Account Holder Signature:_________________________________________________________ Date:__________________
Account Holder Signature:_________________________________________________________ Date:__________________
TYPE OF AUTOMATIC DEPOSIT:
❒
Employee Payroll
❒
Pension/Retirement
❒
Investment Income
❒
Social Security (Additional forms required – www.ssa.gov)
❒
Other (Please Specify)___________________________________________________________
Please acknowledge your receipt of this notice by sending confirmation of this change to the address
listed under RECIPIENT INFORMATION. Please notify recipient immediately if this form is not sufficient
to complete the requested change.
The company or organization that issues the direct deposit.
The person into
whose account the direct deposit is made.
Member FDIC Equal Housing Lender
© Bangor Savings Bank 2006
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Consumer Direct Deposit Authorization Quick Swith Kit Personal V5.indd (Bangor Savings Bank)

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Completed 18 July 2020

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