Direct deposit enrollment form
Sign and deliver this form to your employer or payroll provider, and we’ll take care of the rest.
Voided check
PAY TO THE
ORDER OF
VOID
ROUTING NUMBER
073972181
0000
$
DOLLARS
BANK NAME
MetaBank
Authorization
Direct Deposit via ACH is the deposit of your payroll, government benefits, tax and other
refunds, annuities, and interest payments to your Coinbase Account.
I authorize
(employer / payer) to electronically deposit my
paycheck to my Coinbase Account
(account number1) and, if
necessary, debit entries and adjustments for any errors to my account each pay period2. This
authority will remain in effect until I notify my employer or payer in writing or as otherwise
specified by my employer.
Choose deposit amount (per pay period)
Deposit my entire paycheck
Deposit $
of my paycheck
dollars
Deposit
of my paycheck
YOUR NAME
YOUR SIGNATURE
DATE
%