FirstBank OnBoarding Manual - Flipbook - Page 158
DIRECT DEPOSIT
Vendor ACH / Direct Deposit Agreement Form
Authorization Agreement
I hereby authorize FirstBank to initiate automatic deposits to my account at the financial institution named
below. Further, I agree not to hold FirstBank responsible for any delay or loss of funds due to incorrect or
incomplete information supplied by me or by my financial institution or due to an error on the part of my
financial institution in depositing funds to my account. Deposit will be made electronically when Accounts
Payable checks are printed. This agreement will remain in effect until FirstBank receives a written notice of
cancellation from me or my financial institution, or until I submit a new direct deposit form to the Accounts
Payable Department.
Please scan completed form to:
apinvoices@FirstBankonline.com
Payee Information
Name (First & Last):
Company Name (If applicable):
Account Address:
Statement Address
Email Address:
For remittance Advice
Account Information
Name of Bank:
Account No.:
Checking
Savings
Routing No.:
Account and routing number can be
found at the bottom of your checks
Signature
Print Name:
Date:
Auth Signature:
157
Onboarding Manual
Confidential. Property of FirstBank. Not for Distribution.
