Direct Deposit Application

With Direct Deposit, your payroll check, social security, or other regular payment is automatically deposited electronically into your Union State Bank checking account, money market account or savings account, - immediately, on schedule, and at no cost to you. It's easy to enjoy the convenience, safety, and security of Direct Deposit. Simply provide your employer, social security office, or other payment source with the completed Direct Deposit form. Complete the information on this form, print it, and give it to your payment source. It's that simple.

Prefix
First Name
Middle Name
Last Name
Suffix (e.g., Jr., Sr., MD)
Street Address
Apt. Number
City
State
Zip Code
Home Phone - -
Day Time Phone - - x
Email (e.g. phs@internet.com)
Social Security
Number
- -
Date of Birth
HomeBanking Account Number
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Electronic Banking Disclosure

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