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Camp Buffalo Bill Direct Deposit Form
Instructions:
Please fill out the form below and attach a voided check or other document* verifying the correct routing number and account number.
*If a voided check is unavailable, please check to make sure that the document provided (deposit slip, photocopy of account card, or other) has the
correct routing number and your account number. If you are not sure, call your financial institution to verify. For example, Wells Fargo, US Bank, Bank
of the West and others DO NOT have the correct routing number on deposit slips- a voided check is needed to obtain the correct number.
Employee Name____________________________________________________
Name of Bank / Branch_______________________________________________
Routing Number_____________________________________________
Account Number_____________________________________________
Circle one:
Checking
Savings
Deposit Start Date______________________
Deposit End Date (if left blank, deposit will continue until cancelled by you)____________________
SIGNATURE______________________________________DATE_________________