Direct Deposit Authorization Form

Fill out this form and turn it in to your employer.

Full Name

Address

Address Line 2

City

State

Zip

Phone Number

Effective Date

Webster First Federal Credit Union

Routing Transit Number

211386597

Account Number (ACH Number)

Type of Account

Checking

Savings

I hereby Authorize (my employer) to initiate direct deposit of my wages to the account indicated above.

Signature

Date

Please complete all fields and click Save to PDF. Then print and sign this form and provide it to your employer. For questions contact us at 1(800) 962-4452.

VOID

1000

Pay to the Order of:

Dollars

For:

T211386597T

1000