SMBK DEP2014B 0312 DIRECT DEPOSIT — Page 1 of 2
DIRECT DEPOSIT FORM
It’s easy to set up direct deposit. Just complete this form and return it to your payroll department for processing. For more information
about how to set up direct deposit for other forms of compensation please refer to page two.
1. DIRECT DEPOSIT ALLOCATION
You can direct deposit the entire net amount of your paycheck into a single Sallie Mae account. Or, you can elect to divide it between two accounts,
depositing a portion or percentage into your primary Sallie Mae account and the remaining amou
nt into an account with another bank.
Method (please check one of the following):
Deposit 100% of my paycheck into my into my primary Sallie Mae account.
Divide my paycheck between two accounts:
%
%
Primary Sallie Mae Account Secondary Optional Account
Deposit a portion of my paycheck into my primary Sallie Mae account and the remainder into my secondary optional account.
$
, .
Primary Account Portion
Date Effective (please check one of the following):
Immediately Effective of this date:
Date (mm/dd/yyyy)
2. ACCOUNT INFORMATION
Primary Sallie Mae Account
SALLIE MAE
Bank Name
911583421
Account Type:
Bank Routing Number Bank Account Number (check one) Checking Savings
2. Secondary Optional Account (Complete this section to send a portion of your direct deposit to another account.)
Bank Name
Account Type:
Bank Routing Number Bank Account Number (check one) Checking Savings
3. ACCOUNT OWNER AUTHORIZATION AND SIGNATURE — YOU MUST SIGN BELOW
I authorize
(the source of my payments) to initiate credit entries
and, if necessary, to initiate any debit entries to correct erroneous credit entries to my account at Sallie Mae. I understand that this authorization
replaces any previous authorization and will remain in full force and effect until the company named above has received written notification from
me of its termination in such time as to afford the company and depository a reasonable opportunity to act.
Account Owners Name (first and last)
SIGNATURE
Signature of Account Owner Date (mm/dd/yyyy)
