Senath State Bank Direct Deposit Form

Please complete the direct deposit form and forward it to your payroll department for faster processing.

Authorization Code: New Change Cancel  I authorize you and Senath State Bank to initiate electronic credit entries,  and if necessary, debit entries and adjustments for any credit entries in error to my:   Checking Account #    $    Savings Account #    $   each pay period. This authority will remain in effect until I have cancelled it in writing.
Financial Institution Information	Account Holder Information
Financial Institution: Senath State Bank	Name (Please print):
Address: 117 Commercial Street	SS#:
City, State, Zip: Senath, MO 63876	Signature:
Employer Name:	Date:
Address:
City, State, Zip:

081518016 TRANSIT ROUTING NUMBER (ABA)

STAPLE VOIDED CHECK HERE.

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