Georgia’s Own Direct Deposit Form
Employer/Company name
Employer Address City State Zip
Name
Address City State Zip
Funds will be deposited in the account(s) and information stated below:
Type of Account: Checking Savings Investment Account
Routing number: 261071438
Account number:
Amount: Net Pay or % or Dollar Amount
“I authorize to schedule a direct deposit as listed above
Signature: Date:
click to sign
signature
click to edit