Direct Deposit Authorization Agreement Form printable pdf download

Direct Deposit Authorization Agreement Form

Direct Deposit Authorization Agreement

Durett Business Management Corp.

Employee No.

I hereby authorize Durett Business Mgt. Corp. hereafter called Durett Business Mgt. Corp. to

initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit

entries in error to my (our) account indicated below and the depository named below, hereafter

called DEPOSITORY, to credit and debit the same entries to such account.

DEPOSITORY NAME: ________________________________________________________

CITY: _____________________________ STATE: ________________ ZIP: ____________

BANK TRANSIT NO: ____________________ ACCOUNT NO:______________________

( ) CHECKING

( ) SAVINGS

This authorization is to remain in full force and effect until Durett Business Mgt. Corp. has

received written notification from me on its termination in such time and in such manner as to

afford Durett Business Mgt. Corp. a reasonable time to act on it.

NAME: (print) _____________________________ SSN: _____________________________

SIGNATURE: __________________________________ DATE: ______________________

COSIGNATURE (IF JOINT ACCOUNT):

______________________________________________ DATE: ______________________

EMPLOYER NAME __________________________________________________________

NOTE:

ATTACH VOIDED BLANK CHECK

Jane A. Doe

1000 Main St.

Anywhere, USA 10001

_______________20______

PAY TO THE

ORDER OF _____________________________________________ $ ______________

______________________________________________________________DOLLARS

MEMO _________________________

____________________________________

Transit No.

Account No.

Check No.

Direct Deposit Authorization Agreement Form