Direct Deposit / Pay Card Enrollment

Name*

First NameLast Name

Social Security Number*

xxx-xx-xxxx

IS Email

example@example.com

Email*

example@example.com

Direct Deposit or Pay Card?*

Direct Deposit - By choosing traditional direct deposit, your pay will be deposited directly into your checking account each paydayFocus Card - With the US Bank Focus Card, your pay will be deposited onto a prepaid Visa card. Your card can be used anywhere Visa debit cards are accepted worldwide. It's not a credit card and there is no cost to enroll.

Are You Depositing your Paycheck into a single Bank account, or multiple accounts?*

1 Bank AccountMultiple Accounts

Bank Account

What is you Bank Name? Bank Name*

Checking or Savings Account?


Account #:   Account*

Routing #:   Routing *

Please upload a picture of a voided check for this account*

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Bank Account 1

What is you Bank Name? Bank Name*

Checking or Savings Account?


Account #:   Account*

Routing #:   Routing *

Bank 1 - Please upload a voided check or your Financial Institution’s Direct deposit form*

Browse Files

Bank Account 2

What is you Bank Name? Bank Name*

Checking or Savings Account?


Account #:   Account*

Routing #:   Routing *

Dollar Amount of 2nd Deposit Dollar Amount*

Bank 2 - Please upload a voided check or your Financial Institution’s Direct deposit form*

Browse Files

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial insititutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you:when you open an account we will ask your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other idnetifying documents.

If you have Direct Deposit or Pay Card, you will automatically stop receiving paper check stubs in the first week you recieve a direct deposit unless you indicate on this form that you wish to receive paper stubs.

I elect to access my pay stubs online only. I acknowledge that I will no longer receive paper stubs. (Default if no selection is made)I wish to receive paper stubs

Please allow at least two payroll dates before your direct deposit will begin at your financial institution. You will continue to receive payroll checks until the pre-note process has been completed.

I hereby authorize my employer to initiate credit entires (deposits) and to initiate, if necessary, devit entries and adjustments for any credit entries in error to my Focus Card or bank account. This authorization will remain in effect until cancelled by me with written notification to my employer

I authorize IntelliSource and the financial institution listed on my viced check to deposit my net pay into my account(s) on each payday. I understand that if funds to which I am not entitled (i.e. overpayment) are deposited to my account, my financial insititution will return those funds to IntelliSource. I undersatand that my deposit may not be credited to my account until 5:00 P.M. on the date indicated on the pay advice.

Signature*

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