Direct Deposit Authorization Form
(Nonprofit)
Employee/Payee Information
Full Name
Address
City
State
ZIP Code
Email Address
Phone Number
Bank Information
Bank Name
Bank Branch
Account Type
Checking
Savings
Routing Number
Account Number
Authorization
I authorize the nonprofit organization to initiate direct deposit of payments to the bank account listed above. This authorization will remain in effect until I notify the organization in writing to cancel or change it.
Signature
Date