Direct Deposit Set-Up/Change Form

First Name

Last Name

Phone *

Email *

Do you want to divide your paycheck between multiple accounts?

Bank Account Information

You can have you pay check deposited in up to 2 bank accounts of you want.

Bank Account #1

Bank Name

9 Digit Routing Number

Account Number

How Much Do You Want Deposited Into This Account? *

100%

Specific Dollar amount

What is the specific dollar amount you want deposited or the percentage of your pay check you want deposited in this account?

Bank Letter or Voided Check

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Bank Account #2 (optional)

Bank Account #2-Name

Bank Account #2- 9 Digit Routing Number

Bank Account #2- Account Number

How Much Do You Want Deposited Into Bank Account Number 2. *

100%

Specific Dollar amount

What is the specific dollar amount you want deposited or the percentage of your pay check you want deposited into bank account number 2?

Bank Letter or Voided Check matching Bank Account number 2.

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Direct Deposit Security, Fraud Prevention & ACH Authorization Clause

By submitting this form, I certify that the banking information provided is accurate, complete, and authorized for use. I understand and agree that BryVea LLC implements strict security measures to prevent fraud and unauthorized transactions.

I authorie BryVea LLC to verify my identity and banking information prior to processing any direct deposit setup or changes. This may include requesting supporting documentation such as a voided check, bank letter, or government-issued identification, as well as requiring additional confirmation before approval. I understand that any request deemed suspicious, incomplete, or inconsistent may be delayed, rejected, or subject to further review.

I further authorize BryVea LLC to initiate debit entries and adjustments to my bank account, in accordance with applicable laws and NACHA (National Automated Clearing House Association) rules, for the purpose of correcting errors. This includes, but is not limited to, reversing duplicate payments, recovering funds deposited in error, or correcting incorrect deposit amounts.

I acknowledge and agree that any funds deposited into my account in error are not my property and must be returned immediately. I agree not to withdraw, transfer, or use such funds if I am aware of the error. I understand that failure to return funds may result in legal action.

I release BryVea LLC from liability for any loss, delay, or error resulting from inaccurate or unauthorized information provided by me, and I authorize my financial institution to honor all debit entries initiated by BryVea LLC for the purposes stated above.

☐ I have read and agree to the Direct Deposit Security, Fraud Prevention & ACH Authorization Terms.