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Direct Deposit Application

Village Bank Direct Deposit Form
Please complete the direct deposit form and forward it to your payroll department for faster processing.
Authorization Code: emptycheckbox New emptycheckbox Change emptycheckbox Cancel
I authorize you and Village Bank to initiate electronic credit entries,
and if necessary, debit entries and adjustments for any credit entries in error to my:
emptycheckbox Checking Account #account $ amount
emptycheckbox Savings Account #account $ amount
each pay period. This authority will remain in effect until I have cancelled it in writing.
Financial Institution Information Account Holder Information
Financial Institution: Village Bank Name (Please print):
Address: 3350 Bridge St NW SS#:
City, State, Zip: St. Francis MN, 55070 Signature:
Employer Name: Date:
Address:
City, State, Zip:
routingsymbol0919057451routingsymbol
TRANSIT ROUTING NUMBER (ABA)
STAPLE VOIDED CHECK HERE.