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Direct Deposit Authorization
You can use your keyboard to fill out this form online, or you can print the form and complete it by hand.
Company or Employer:
Address:
City, State, Zip:
Phone Number:
Employee ID:
Notication of Direct Deposit Authorization Change
Effective immediately, please deposit the net amount of my check to my Touchstone Bank
account. I authorize (name of depositor)
to automatically deposit funds into the account below. This authorization shall remain in
place until I have submitted a new authorization, or until this authorization is changed or
revoked by me in writing.
Signature:
Name:
Address:
City, State, Zip:
Phone Number:
(if applicable)
Date:
Direct Deposit Checklist:
Payroll
Investments
Retirement Plans
Social Security
Use this form to authorize your employer, retirement and pension funds, or any other agency to deposit your payment
directly into your Touchstone Bank account. Use one form for each direct deposit.
Use this list to remember all
your direct deposits you need
to transfer. These are the most
common direct deposits.
Place an X next to your desired option.
Net amount to Touchstone Bank CHECKING
Net amount to Touchstone Bank SAVINGS
Account #
Routing #
Account #
Routing #
051403931
051403931