Ally Bank Direct Deposit Authorization Form

Information you will need

• What’s the payee’s full name?
• What’s the payee’s address?
• What's the payee's city?
• What's the payee's ZIP code?
• What's the payee's state?
• What’s the payee’s phone number?
• What’s the account type?
• What’s the bank account number?
• What dollar amount will be deposited?
• What percentage will be deposited?
• Should the full amount be deposited?
• Who’s the payor?
• Should the remaining amount be deposited?

Completed by the employer and the provider.