Direct Deposit

Setting Up Direct Deposit

 

To begin, change or cancel the transmittal of workers’ compensation benefit checks and/or proceeds from a settlement agreement pursuant to WCL § 32 (hereinafter settlement proceeds) directly to a financial institution: fill out this form and submit directly to us,

Attn: Accounting, SAFE, LLC, 2556 Hambletonian Way, Camillus, New York 13031.

Do not send to the Workers’ Compensation Board. If you need a paper copy of the form, please let us know and we will provide that for you.

Download Direct Deposit Authorization Form as a PDF

Download Direct Deposit Authorization Form as a Word Doc