1. Complete the fields on this form. 2. Print and sign the form
3. Give it to your employer or benefits provider.
DEPOSIT AMOUNT
Indicate the amount you want deposited per pay period.
ENTIRE CHECK AMOUNT
(100% of check)
% OF CHECK
(100% of check)
$PER CHECK
(100% of check)
INSTRUCTIONS FOR BANK:
Account type - Checking
NOT NEGOTIABLE
This form is provided to facilitate direct deposit only.
Your ion Visa® Prepaid Card bank routing number and associated direct deposit account number cannot be used for preauthorized direct debits from merchants or from utility or Internet service providers.
If presented for payment, these preauthorized direct debits will be declined and your payment to the merchant will not be processed. The bank routing number and direct deposit account number are for the purpose of initiating direct deposits to your ion Visa Prepaid Card account only. You are not authorized to provide this bank routing number and direct deposit account number to anyone other than your employer or payer. I request to have my paycheck or benefits deposited directly to my ion Visa Prepaid Card account at The Bancorp Bank. I authorize you (my employer or payer) to electronically deposit my check to my ion Visa Prepaid Card account at The Bancorp Bank. The Bancorp Bank is authorized to initiate credit or debit entries or, if necessary, to correct any credit entries made in error to my account. This authorization will stay in effect with you (my employer or payer) and The Bancorp Bank until written notice is received to change or terminate this authorization. Direct deposit capability is subject to payer’s support of this feature. Check with your payer to find out when the direct deposit of funds will start. Funds availability is subject to timing of payer’s funding. For Additional Assistance call 866.692.9356. The ion Visa Prepaid Card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. and may be used everywhere Visa debit cards are accepted. The Bancorp Bank; Member FDIC.