• for all your ages and stages

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: 3550 Bridge Street NW SS#:
City,
State, Zip: St. Francis, MN 55070
Signature:
Employer Name: Date:
Address:
City,
State, Zip:

routingsymbol 0919057451 routingsymbol
TRANSIT ROUTING NUMBER (ABA)

STAPLE
VOIDED CHECK HERE.