Authorization For Direct Deposits - Employee Form

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Authorization Form
Authorization for Direct Deposits - Employee Form
Little Rock-Fox Fire Protection District
This authorizes _______________________________________________ (the "Company") to send credit entries (and
appropriate debit and adjustment entries), electronically or by any other commercially accepted method, to my (our)
account(s) indicated below and to other accounts I (we) identify in the future (the "Account"). This authorizes the
financial institution holding the Account to post all such entries.
Account #1
*Deposit (amount or %)
*ACCOUNT TYPE (e.g. Checking or Savings)
*EMPLOYEE BANK NAME
BRANCH
CITY, STATE
*ACCOUNT NUMBER
*BANK ROUTING NUMBER (ABA#)
Account #2
Deposit (amount or %)
ACCOUNT TYPE (e.g. Checking or Savings)
EMPLOYEE BANK NAME
BRANCH
CITY, STATE
ACCOUNT NUMBER
BANK ROUTING NUMBER (ABA#)
This authorization will be in effect until the Company receives a written termination notice from myself and has a
reasonable opportunity to act on it.
________________________________________________________________
*SIGNATURE
________________________________________________________________
*PRINTED NAME
_______________________________________________
*DATE
*EMAIL ADDRESS YOU WANT YOUR PAYSTUB SENT TO: ____________________________________________
*Items marked with an asterisk are required in order to process your request.
IMPORTANT: This document must be signed by employees requesting automatic deposit of paychecks, and retained on file by
the employer. Do not send this form to QuickBooks Direct Deposit.

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