Direct Deposit Authorization Form
TD Bank makes setting up direct deposit easy with this convenient, pre-filled form. There are two types of
direct deposit enrollment available: Federal Government Benefit Compensation and Payroll Compensation.
Steps to enroll for each are outlined below.
1. Federal Government Benefit Compensation:
To sign up for direct deposit of your federal benefit payments such as Social Security,
SSI or VA Compensation and Pension Payment, visit [Link].
You’ll need your:
• Social security number or claim number • TD Bank’s routing transit number:
• 12-digit federal benefit check number • TD Bank account number:
• Amount of most recent federal benefit check • Type of account (checking or savings):
2. Payroll Compensation
Complete and sign this direct deposit form and give it to your employer’s payroll representative – it’s that easy!
Employee name and address:
JUAN DELGADO MATUTE
10818 38TH AVE APT 1F
CORONA NY USA 11368-2015
Employee phone number:
(347) 832-5460
Employee ID:
(if applicable)
Employee social security number:
Please begin directly depositing my payroll and/or dividend or annuity check into my account at TD Bank.
Direct deposit the following:
o Total net check amount
✔
o The set amount of $_____________________________ of my net check each period.
Bank name: TD Bank, N.A.
Address: 32 Chestnut St.
P.O. Box 1377
Lewiston, ME 04243-1377
TD Bank routing transit number: 0260-13673
TD Bank account number: 4393742303
Type of account: o Checking
✔ o Savings
Employee signature Date
Member FDIC, © 2022, TD Bank, N.A. and/or its affiliates. | All Rights Reserved. 11440C-CHK (1022)