Fillable Direct Deposit Authorization Form

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Direct Deposit Authorization Form

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The Direct Deposit Authorization Form form is 1 page long and contains:

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  • 4 check-boxes
  • 10 other fields

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File type: PDF

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1. Federal Government Benefit Compensation:
To sign up for direct deposit of your federal benefit payments such as Social Security, SSI or VA Compensation and Pension Payment
•฀Go฀to฀the฀U.S.฀Department฀of฀the฀Treasury฀website:฀www.godirect.org, or
•฀Enroll฀by฀phone฀by฀calling฀the฀U.฀S.฀Department฀of฀the฀Treasury฀toll฀free฀at:฀1-800-333-1795
You’ll฀need฀your:
•฀Social฀security฀number฀or฀claim฀number
•฀12-digit฀federal฀benet฀check฀number
•฀Amount฀of฀most฀recent฀federal฀benet฀check
•฀TD฀Bank’s฀routing฀transit฀number:
•฀TD฀Bank฀account฀number:
•฀Type฀of฀account฀(checking฀or฀savings):
2. Payroll Compensation
Complete and sign this direct deposit form and give it to your employer’s payroll representative – it’s that easy!
Employee฀name฀and฀address:
Employee฀phone฀number:
Employee฀ID:
(if฀applicable)
Employee฀social฀security฀number:
Please฀begin฀directly฀depositing฀my฀payroll฀and/or฀dividend฀or฀annuity฀check฀into฀my฀account฀at฀TD฀Bank.
Direct฀deposit฀the฀following:
o฀Total฀net฀check฀amount
o฀The฀set฀amount฀of฀$_____________________________฀of฀my฀net฀check฀each฀period.
Bank฀name: TD฀Bank,฀N.A.
Address: 32฀Chestnut฀St.
P.O.฀Box฀1377
Lewiston,฀ME฀04243-1377
TD฀Bank฀routing฀transit฀number:
TD฀Bank฀account฀number:
Type฀of฀account: o฀Checking฀฀฀฀฀o฀Savings
Employee฀signature Date
TD Bank makes setting up direct deposit easy with this convenient, pre-filled form. There are two types of
direct deposit enrollment available: Federal Government Benefit Compensation and Payroll Compensation.
Steps to enroll for each are outlined below.
11440C-CHK (03/16)
Direct Deposit Authorization Form
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Direct Deposit Authorization Form

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Completed 22 November 2021

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