Authorization Agreement
For Direct Deposit of Vacation/Holiday Benefits
Electrical Construction Industry Vacation/Holiday Plan
I hereby authorize the Electrical Construction Industry Vacation Holiday Plan to
directly deposit my Vacation/Holiday benefits into my account at the bank
designated below.
Financial Institution: ________________________________________________
Address: __________________________________________________________
City & State: ______________________________________ Zip: ____________
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For Deposit To:
Checking __ __ __ __ __ __ __ __ __ _________________
Bank Routing Number
Account Number
PLEASE ATTACH A VOIDED CHECK
□
Savings __ __ __ __ __ __ __ __ __ _________________
Bank Routing Number
Account Number
PLEASE ATTACH A DEPOSIT SLIP
To correct any overpayments credited to my account during or after my lifetime, I
hereby authorize the bank designated to debit my account and to refund any such
overpayment to the Electrical Construction Industry Vacation/Holiday Plan.
________________________________
________________________________
Name (Please Print)
Social Security Number
________________________________
Signature
________________________________
Date