Direct Deposit Waiver Agreement Form

Direct Deposit Waiver Agreement Form
I hereby authorize Tower Legal Staffing, Inc. to initiate automatic deposits to my account at the
financial institution named below.* I also authorize Tower Legal Staffing, Inc. or its designated
agent to make withdrawals from this account in the event that credit entry is made in error.
Further, I agree not to hold Tower Legal Staffing, Inc. responsible for any delay or loss of funds
due to incorrect or incomplete information supplied by me or my financial institution, or due to
an error on the part of my financial institution, or until I submit a new direct deposit form to
the Payroll Department.
This agreement will remain in effect until Tower Legal Staffing, Inc. receives a written notice of
cancellation from me or my financial institution, or until I submit a new direct deposit form to
the Payroll Department.
NAME AS IT APPEARS ON YOUR ACCOUNT: __________________________________________
NAME OF FINANCIAL INSTITUTION: _________________________________________________
ROUTING NUMBER: _____________________________________________________________
ACCOUNT NUMBER: ___________________________
CHECKING
SAVINGS
I authorize Tower Legal Staffing, Inc. to waive the ten business days verification process
and activate my direct deposit agreement immediately. I agree not to hold Tower Legal Staffing,
Inc. responsible for any delay or loss of funds due to incorrect or incomplete information
supplied by me or my financial institution.
Authorized Signature (Primary): __________________________________ Date: ____________
Authorized Signature (Joint): _____________________________________ Date: ____________
* It takes ten business days to verify account information and to activate direct deposit
agreement.
Please attach a voided check and return this form to the Human Resources Department