Direct Deposit Form

I authorize my employer, named above and Customers Bank to automatically deposit my payroll check into my account listed above. I further authorize my employer, named above and Customers Bank to return monies deposited to my account that I am not entitled to receive.

This authority will remain in e�ect until my employer has received written notification from me of its termina-tion in such time as to a�ord employer and Customers Bank a reasonable opportunity to act on it.

Employee Name

Financial Institution: Customers Bank

Employer

Signature Date

Complete the form below and submit to your employer.

Your payroll department may require a voided check.

Email Address

113024588

Account Number Routing Number

Physical Address

BankMobile a Division of Customers Bank. All Rights Reserved. Accounts held at Customers Bank, Member FDIC and Equal Housing Lender.

Please download form to e-sign

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