• it takes a village

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:

 

 

 

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TRANSIT ROUTING NUMBER (ABA)

 

 

 

 

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