Direct Deposit Authorization
Chick-fil-A West End · Complete by hand and return in person
Employee
Full name
Date
Position / role
Phone
Bank Account
Bank name
Routing number (9 digits)
Account number
Account type
Checking Savings
Voided check (recommended)
Tape or staple a voided check here to confirm your account and routing numbers.
Authorization
I authorize Chick-fil-A West End to deposit my net wages directly into the bank account listed above, and to make any needed adjustments for deposits made in error. This authorization stays in effect until I provide written notice to cancel or change it. I certify the account information above is correct.
Signature
Date
Return this completed form directly to Austen — hand it to him in person. Please do not email, text, or photograph it. Your bank details stay on paper.
For payroll setup only. Chick-fil-A West End keeps this form secure and uses it solely to enroll you in direct deposit.