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Direct Deposit Enrollment Form

Account Inf ormation
Na m e : Johnnie Willis
B a nk Na m e : The Bancorp Bank
Ad d re s s : 6100 S Old Villag e Pl, Sioux Falls, SD
57108
R o uting Num be r: 031101279
Acco unt Num be r: 156115443129

Amount
Deposit my entire paycheck. Deposit $ dollars of Deposit % of my
my paycheck. paycheck.

Voided Check

The Bancorp Bank 123

Johnnie Willis

VOID
1448 Woods ide Ct S ,
Che s ape ake , VA 23320

PAY TO THE $
ORDER OF

DOLLARS

FOR

A031101279 C156115443129 C123

The i ma g e o f thi s vo i d e d c he c k ma y b e p ro vi d e d to yo ur e mp l o ye r o r o the r p a ye r fo r no o the r p urp o se e xc e p t to se t up d i re c t d e p o si t to yo ur Chi me Ac c o unt.

Authorization
I authorize (employer/payer) to initiate credit entries, and, if necessary to initiate any debit entries
to correct previous credit errors, to my Chime Spending Account. This authority will remain in effect until I notify my employer
or other payor in writing or as otherwise specified by my employer or payer.

Signat ure Dat e

B a nk i ng Se rvi c e s p ro vi d e d b y The B a nc o rp B a nk , M e mb e r F D I C. The Chi me Vi sa ® D e b i t Ca rd i s i ssue d b y The B a nc o rp B a nk p ursua nt to a l i c e nse fro m Vi sa U .S.A. I nc . a nd ma y
b e use d e ve rywhe re Vi sa d e b i t c a rd s a re a c c e p te d .
D i re c t d e p o si t c a p a b i l i ty i s sub j e c t to p a ye r' s sup p o rt o f thi s fe a ture . Che c k wi th yo ur p a ye r to fi nd o ut whe n the d i re c t d e p o si t o f fund s wi l l sta rt. F und s a va i l a b i l i ty i s
sub j e c t to ti mi ng o f p a ye r’s fund i ng .
The re c i p i e nt’s na me o n a ny d e p o si ts re c e i ve d must ma tc h the na me o f the Chi me M e mb e r. Any d e p o si ts re c e i ve d i n a na me o the r tha n the na me re g i ste re d to the Chi me
Sp e nd i ng Ac c o unt wi l l b e re turne d to the o ri g i na to r.