DIRECT DEPOSIT ELECTION FORM
First Priority Deposit
Type of account: Checking Savings
Bank Name:
Routing Number:
Account Number:
Amount: $ OR ENTIRE AMOUNT (if left blank)
Second Priority Deposit
Type of account: Checking Savings
Bank Name:
Routing Number:
Account Number:
Amount: REMAINING AMOUNT ONLY
Employees Signature:
Employees Printed Name:
Date: