Western Omelette Direct Deposit

"*" indicates required fields

Employee Information

Name*

First Last

Phone*

Used for identity verification.

Date*

Please select today's date.

Email*

Bank Account Information

Please complete all fields

Account #1*

You are able to select two separate accounts. Please select the primary account where the majority of your deposit will be sent. This can be a checking or savings account.

Name of Financial Institution*

Please provide the name of your financial institution here.

Routing Number*

Account Number*

Account Information Document*

Max. file size: 10 MB.

Please chose a file, or take a photo of your financial institution document displaying your account information.

Second Account Information

Please complete this section if you would like a portion of your paycheck deposited into a second account.

Account #2

If you would like a portion of your check to be deposited into a second account, please select that account type here. This can be an account at a different bank, if you have more than one checking, or savings accounts.

Amount or Percentage You would like deposited into account #1*

The remaining amount will be deposited into this account.

Name of Financial Institution*

Please provide the name of your financial institution here.

Routing Number*

This is your second account.

Account Number*

This is your second account.

Account Information Document*

Max. file size: 10 MB.

Please chose a file, or take a photo of your financial institution document displaying your account information.

Signature*

Name

This field is for validation purposes and should be left unchanged.