Direct Deposit/Payroll Deduction Authorization

Use this form to initiate a Direct Deposit into your The Bancorp Bank

Direct Deposit/Payroll Deduction Authorization for my The Bancorp Bank, N.A. Account

1. Complete Part A of this authorization form.

2. Staple a voided check or deposit slip for each account that will be receiving funds onto Part B.

3. Sign at Part C.
4. Return the completed form to your employer.

Part A

I authorize ________________________________(employer name) to initiate credit entries, and, if necessary, to initiate any debit entries to correct a previous credit error, to my account at The Bancorp Bank. I authorize the following credit to be made (check only one box):

    Employer Contribution.
    Credit my entire net paycheck.
    Credit $______________ of my net pay.
    Credit ______________% of my net pay.
    Credit $______________ of my net pay into account one and $___________ into account two.
    Credit ______________% of my net pay into account one and ___________% into account two.

Part B

STAPLE VOIDED CHECK OR DEPOSIT SLIP FOR ACCOUNT ONE

STAPLE VOIDED CHECK OR DEPOSIT SLIP FOR ACCOUNT TWO

Part C

I understand that this authorization replaces any previous authorization and will remain in effect until my employer receives written notification from me of its termination.

Name: _______________________________________

Signer: _______________________________________

Date: ____________________

Banking Services provided by The Bancorp Bank. Member FDIC. Equal Housing Lender