FIRST
AMERJCAN
BANK
________________________________________________________________
Direct Deposit Authorization Form
To: ____________________________________________ (henceforth the “Company”)
employer / company name
____________________________________________
employer / company address
____________________________________________
city state zip
Effective ____/____/______, I authorize the Company to credit my First American Bank Checking
and/or Savings accounts indicated below and to credit the amounts below.
Bank Name: First American Bank
ABA Routing Number: 071922777
Account Type:
□
Checking
□
Savings
Account Number: ____________________________
Deposit Amount: ___________ % OR $ ___________ (flat amount) OR
□
Remaining
Account Type:
□
Checking
□
Savings
Account Number: ____________________________
Deposit Amount: ___________ % OR $ ___________ (flat amount) OR
□
Remaining
*If the employer/company prefers or requires their own form, use the account type, number and
ABA routing number above to help complete their form.*
Customer Authorization
first name middle name last name (print)
_______________________________________
address
_______________________________________
city state zip
Signature ___________________________________________________ Date ________________
