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Direct Deposit Enrollment Form: The Bancorp Bank 123

This document is a Direct Deposit Enrollment Form for Shahim Lopez, providing account information for setting up direct deposit to a Chime Spending Account at The Bancorp Bank. It includes options for the amount to be deposited and requires authorization for the employer to initiate credit entries. The form also contains a voided check image for the employer's use and outlines important terms regarding direct deposit capabilities and fund availability.

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lopezshahim54
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23 views1 page

Direct Deposit Enrollment Form: The Bancorp Bank 123

This document is a Direct Deposit Enrollment Form for Shahim Lopez, providing account information for setting up direct deposit to a Chime Spending Account at The Bancorp Bank. It includes options for the amount to be deposited and requires authorization for the employer to initiate credit entries. The form also contains a voided check image for the employer's use and outlines important terms regarding direct deposit capabilities and fund availability.

Uploaded by

lopezshahim54
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Member Services

(844) 244-6363
[email protected]

Direct Deposit Enrollment Form


Account Information
Name: Shahim Lopez
Bank Name: The Bancorp Bank
Address: 6100 S Old Village Pl, Sioux Falls, SD 57108
Routing Number: 031101279
Account Number: 169152370238

Amount
Deposit my entire paycheck. Deposit $ dollars of Deposit % of my
my paycheck. paycheck.

Voided Check

The Bancorp Bank 123


Shahim Lopez

VOID
63 Center St, # 1
West Haven, CT 06516

PAY TO THE $
ORDER OF

DOLLARS

FOR

A031101279 C169152370238 C123

The image of this voided check may be provided to your employer or other payer for no other purpose except to set up direct deposit to your Chime Account.

Authorization
I authorize (employer/payer) to initiate credit entries, and, if necessary to initiate any debit entries to
correct previous credit errors, to my Chime Spending Account. This authority will remain in effect until I notify my employer or
other payor in writing or as otherwise specified by my employer or payer.

Signature Date
Banking Services provided by The Bancorp Bank, Member FDIC. The Chime Visa ® Debit Card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. and may be used everywhere Visa debit cards
are accepted. Direct deposit capability is subject to payer's support of this feature. Check with your payer to find out when the direct deposit of funds will start. Funds availability is subject to timing of payer’s
funding. The recipient’s name on any deposits received must match the name of the Chime Member. Any deposits received in a name other than the name registered to the Chime Spending Account will be
returned to the originator.

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