Member FDIC. CS11739 (1/16)
Direct Deposit Authorization Form
To: __________________________________________________________________________________
(Company Name/Employer)
I authorize you to electronically deposit my pay as directed to my account(s) listed below:
NOTE: Funds can be deposited into one account or split between accounts as a set percent or dollar amount.
ACCOUNT TYPE: Checking Savings
(Attach a voided M&T Bank Check or pre-printed Savings Withdrawal Ticket to help ensure accuracy)
Account Number: _________________________ ABA/Routing Number: ___________________________
(first 9 digits located at the bottom left corner of your checks or withdrawal tickets)
Deposit Amount: __________% OR $__________ (flat amount) OR Remaining
ACCOUNT TYPE: Checking Savings
(Attach a voided M&T Bank Check or pre-printed Savings Withdrawal Ticket to help ensure accuracy)
Account Number: _________________________ ABA/Routing Number: ___________________________
(first 9 digits located at the bottom left corner of your checks or withdrawal tickets)
Deposit Amount: __________% OR $__________ (flat amount) OR Remaining
ACCOUNT TYPE: Checking Savings
(Attach a voided M&T Bank Check or pre-printed Savings Withdrawal Ticket to help ensure accuracy)
Account Number: _________________________ ABA/Routing Number: ___________________________
(first 9 digits located at the bottom left corner of your checks or withdrawal tickets)
Deposit Amount: __________% OR $__________ (flat amount) OR Remaining
Please use the following personal information and signature as authorization, or to contact me with
any questions.
Name (First/Middle/Last): ___________________________________________________________________
Street Address: _________________________________________________________________________
City: ___________________________________ State: ___________ Zip Code: ___________________
Social Security Number (If required by employer): _________________________________________________
Daytime Phone Number: __________________ Employee Number (If applicable): ___________________
Signature (Required): ______________________________________________ Date: __________________
When you have completed this form, submit it to your employer’s payroll department.
Contact your employer or income source to make sure no other special forms are required.
M&T Bank Routing Numbers:
022000046 – New York, New Jersey and Connecticut
031302955 – Pennsylvania and Delaware
052000113 – Maryland, Virginia, West Virginia and DC
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