This form contains 62 fields organized into 5 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
First Bank Account
Bank Name, City, State	Text	Enter the full name of the bank, including its city and state, for the first account.
Routing and Transit Number	Text	Enter the routing and transit number for the first bank account. Max length: 9 characters
Account Number	Text	Enter the account number for the first bank account.
Checking Account	Checkbox	Check this box if the first direct deposit account is a checking account.
Savings Account	Checkbox	Check this box if the first direct deposit account is a savings account.
Entire Net Pay	Checkbox	Check this box if you want your entire net pay to be deposited into this first bank account.
Fixed Deposit Dollar Amount	Number	Enter the whole dollar amount to be deposited into this account.
Fixed Deposit Cents Amount	Number	Enter the cents portion of the fixed dollar amount to be deposited into this account.
Percentage to Deposit	Number	Enter the percentage of net pay to be deposited into this account.
General
SS1	Text
SS2	Text
SS3	Text
SS4	Text
Routing1	Text
Routing2	Text
Routing3	Text
Routing4	Text
Routing5	Text
Routing6	Text
Routing7	Text
Routing8	Text
Routing9	Text
aRouting1	Text
aRouting2	Text
aRouting3	Text
aRouting4	Text
aRouting5	Text
aRouting6	Text
aRouting7	Text
aRouting8	Text
aRouting9	Text
bRouting1	Text
bRouting2	Text
bRouting3	Text
bRouting4	Text
bRouting5	Text
bRouting6	Text
bRouting7	Text
bRouting8	Text
bRouting9	Text
Important!
Printed Name	Text	Please enter your full printed name as it appears on official documents.
Social Security Number	Text	Please enter your full Social Security Number. Max length: 4 characters
Date	Date	Please enter the current date when signing the form.
Company	Text	Please enter the name of your employer company.
Second Bank Account
Bank Name, City, State	Text	Please provide the name of the bank, its city, and its state for the second account.
Routing & Transit Number	Text	Please provide the routing and transit number for the second bank account. Max length: 9 characters
Account Number	Text	Please provide the account number for the second bank account.
Checking	Checkbox	Check this box if the second account for direct deposit is a checking account.
Savings	Checkbox	Check this box if the second account for direct deposit is a savings account.
Remaining Net Pay	Checkbox	Check this box if the remaining portion of your net pay, after other direct deposits, should be deposited into this second account.
Deposit Amount Dollars	Number	Please specify the dollar amount to be deposited into the second bank account.
Deposit Amount Cents	Number	Please specify the cent amount to be deposited into the second bank account.
Deposit Percentage	Number	Please specify the percentage of net pay to be deposited into the second bank account.
Third Bank Account
Bank Name, City, & State	Text	Enter the name of the bank, its city, and state for the third direct deposit account.
Routing & Transit Number	Text	Enter the routing and transit number for the third direct deposit account. Max length: 9 characters
Account Number	Text	Enter the account number for the third direct deposit account.
Checking	Checkbox	Check this box if the third bank account is a checking account.
Savings	Checkbox	Check this box if the third bank account is a savings account.
Remaining Net Pay	Checkbox	Check this box if the remaining net pay after other deposits should be deposited into this third bank account.
Deposit Amount Dollars	Number	Enter the whole dollar amount to be deposited into the third direct deposit account.
Deposit Amount Cents	Number	Enter the cents portion of the amount to be deposited into the third direct deposit account.
Deposit Percentage	Number	Enter the percentage of your net pay to be deposited into the third direct deposit account.

Direct Deposit Authorization Form Instructions