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Get and Sign Peoples Direct Deposit 2012-2022 Form
State, Zip
Customer Information
First Name / Middle Initial / Last Name
Phone Number
Address
City, State, Zip
Alternative Phone Number
By signing below, I authorize ______________________ (company name) and Peoples Bank to automatically
deposit my check into the account listed above. This authorization will remain in effect until I have filed a
new authorization or until this authorization is revoked by me in writing.
Signature
Date
X
***Sample Check***
Pay to the
order...
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