Non-Federal Direct Deposit Enrollment Request Form - Authorization agreement for automatic deposits (ACH credits)

Sep 17, 2026

Uploaded by Mary Man

Non-Federal Direct Deposit Enrollment Request Form collects authorization for automatic deposits (ACH credits) to Bank of America Checking and/or Savings accounts. The form instructs users to complete all fields, provide the ABA routing number for the account’s state of opening, and ensure correct employer/company address when mailing. It includes sections for account type, account number, ABA routing number, and deposit amount rules (percentage, flat amount, or remaining). It also covers returning improperly deposited funds and outlines revocation and termination timing.

LanguageEnglish

CategoryForms

FormatPDF

Pages1

AccessFree to download

Directions for Customer Use

Employer/Company mailing and review steps

Authorization terms

ACH credit compliance with U.S. law

Funds return and revocation/termination timing

Account details

Account type, ABA routing number, deposit amount

Signature and date

Reset Non-Federal Direct Deposit Enrollment Request Form Authorization agreement for automatic deposits (ACH credits) Directions for Customer Use: 1) Ensure entire form is complete, then sign and date Use the ABA routing number from the state where your account was opened 2) Ensure appropriate Employer / Company address is used when mailing completed form. 3) Employer/Company should review this form for completeness and suitability. If Employer / Company prefers or requires their own form, use account type, number and ABA routing number below to help complete their form 4) Mail form directly to Employer / Company (Note: It is not necessary for employer or company to return the form to the bank once direct deposit is set up into the payroll system) Employer / Company Name: Employer Address City State Zip I (we) authorize the above named Company to initiate credit entries to my Bank of America Checking and/or Savings accounts indicated below and to credit the same to such amount. I (we) acknowledge that the origination of the ACH transactions to my (our) account must comply with the provisions of U.S. Law. . Account type Checking Savings State Acct Opened Account number ABA Routing Number Deposit Amount % OR $ (Flat Amount) OR Remaining Note: Funds can be deposited into one account or split between accounts as a set percent or dollar amount Account type Checking Savings State Acct Opened Account number ABA Routing Number Deposit Amount % OR $ (Flat Amount) OR Remaining Account type Checking Savings State Acct Opened Account number ABA Routing Number Deposit Amount % OR $ (Flat Amount) OR Remaining If monies to which I am not entitled are deposited to my account, I authorize the Company (issuer) to direct the financial institution to return said funds and I authorize the financial institution to act on the Company's direction and to return said funds. This authority will remain in effect until Employer/Company has received written notification from me of its termination in such time and in such manner as to afford Company and financial institution a reasonable opportunity to act on it. | First Name | Middle Name | Last Name | | | --- | --- | --- | --- | | Address | City | State
- - | Zip | Signature (required) Date Tel Number NOTE: Written credit authorization must provide that the receiver may revoke the authorization only by notifying the originator in the manner specified in the authorization. 00-53-2276NSB 04-2010

FAQs

What information must be completed before signing the form?

The form requires the entire enrollment request to be completed, including account type, account number, ABA routing number, and deposit amount details as specified.

Which ABA routing number should be used?

Use the ABA routing number from the state where the account was opened.

How can the authorization be revoked and when does it remain effective?

Revocation is allowed only by notifying the originator in the manner specified in the authorization. The authority remains in effect until the employer/company receives written notification of termination with time for a reasonable opportunity to act.

Sep 17, 2026

Uploaded by Mary Man