Direct Deposit Authorization Western Omelette Direct Deposit Form Employee InformationName* First Last Phone*Used for identity verification.Date* Date Format: MM slash DD slash YYYY Please select today's date.Address* Street Address City State / Province / Region ZIP / Postal Code Email* Enter Email Confirm Email Bank Account InformationPlease complete all fieldsAccount #1*CheckingSavingsYou 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*Checking Account Number*Re-Enter Checking Account Number*Savings Account Number*Re-Enter Savings Account Number*Second Account InformationPlease complete this section if you would like a portion of your paycheck deposited into a second account.Account #2No Second AccountCheckingSavingsIf 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.Checking Account Number*This is your second account.Re-Enter Checking Account Number*This is your second account.Savings Account Number*This is your second account.Re-Enter Savings Account Number*This is your second account.Consent* I request that my paycheck be deposited to the account(s) listed above.By clicking this box, you authorize Western Omelette LLC to electronically deposit your paychecks to the accounts listed on this form.