GO2bank Direct Deposit Form
GO2bank Direct Deposit Form
Complete and submit the form below to your employer or government benefits provider
to set up direct deposit to your GO2bank™ account. Please note the name and Social
Security number on file with your employer or benefits provider must match your
GO2bank account to prevent fraud restrictions on the account.
Account Information
Amount
Voided check
GO2bank
123
VOID
Michelle Stone
Cearah Reed
9201
22113Sophia
Lange St ave DATE
North hills,Shores,
Saint Clair CA 91343
MI 48080
PAY TO THE
ORDER OF $
DOLLARS
MEMO
A096017418A
124303162 101092248722582C 123
15108634666350
The image of this voided check may be provided to your employer or other payor to set up direct
deposit to your GO2bank account. The voided check cannot be used for any other purpose.
Authorization
I authorize (employer/payor) to electronically deposit my payroll or benefits check to my GO2bank account unless
otherwise revoked. This form and the bank routing number and debit account number are for the purpose of initiating direct deposits to
the associated GO2bank account. Direct deposit capability is subject to payor’s support of this feature. Account holder must check with
payor to find out when the direct deposit of funds will start. Funds availability is subject to timing of payor’s funding.
Signature Date