941_R_ IHA_8-15-21
Direct Deposit enrollment form
Company/Employer Name
Employee name Employee ID
Signature Date
To enroll in Direct Deposit, simply fi ll out this form and give it to your
employer. Some employers require a voided check to be attached.
I authorize the above named Company/Employer to initiate credit entries to the account(s) indicated below, and to
credit the same to such account. I acknowledge that the origination of ACH transaction to my account must comply
with the provisions of U.S. law.
Account information
Primary Direct Deposit account
If no additional accounts are specifi ed, 100% of your net pay to Truist will be deposited into the Primary Account.
Adding additional Direct Deposit accounts
Distributions are made to accounts according to the priority specifi ed. Accounts with the lowest priority numbers are
funded fi rst, with the balance of your pay deposited into your Primary Account.
If monies to which I am not entitled are deposited to my account, I authorize my Company/Employer to direct the fi nancial
institution to return said funds.
This authorization is to remain in full force and eff ect until the Company/Employer has received written notifi cation from
me of its termination in such manner as to aff ord Company/Employer and Truist Bank a reasonable opportunity to act.
Account number
Priority Bank name
Transit routing number
Must be nine digits
Account number Amount (Check one)
999 Truist Bank $ Checking Savings
Priority Bank name
Transit routing number
Must be nine digits
Account number Amount (Check one)
1 Truist Bank $ Checking Savings
2 Truist Bank $ Checking Savings
Routing number
