DIRECT DEPOSIT AUTHORIZATION FORM Employee Name: ___________________________________________________________ I hereby authorize Top Prospect Group, Inc. to deposit my pay directly into the bank account(s) listed below. I have attached a voided check or deposit slip for each account so bank transit and account numbers can be verified. I also authorize Top Prospect Group, Inc. to correct any erroneous payment or overpayment to my account(s) by withdrawing funds in the amount of the excess payment. This authorization remains in effect until Top Prospect Group, Inc. has received written authorization from me of its termination or change. Employee Signature: ______________________________________ Date: ______________ NOTE: If your joint account requires both account holders to sign checks or authorize payments, the joint account holder must indicate their agreement with the above terms by signing below: Financial Institution/Account Number(s): Account 1: ________________________________ ________________________________ Routing Number Account Number Account 2: ________________________________ ________________________________ Routing Number Account Number Name of Joint Account Holder: ___________________________________________________ Please print Signature of Joint Account Holder: ________________________________ Date: ___________ Account Information – Form for Account 1 Complete only this form for Account 1 if you want all of your pay deposited into a single account. If you want your pay per pay period deposited into two accounts, complete both this form for Account 1 and the form for Account 2. Account Type: Checking Savings (Select one) Name of Financial Institution:____________________________________________________ _________________________________________________________________________ Street Address City, State, and Zip Code Telephone Number for Financial Institution: _________________________________________ Percentage or Amount per Pay Period to Deposit for this Account: __________________________ (Use when pay is split between two accounts e.g. 100% or 90% and 10%) Confirm Account 1: __________________________ ______________________________ Routing Number Account Number Company Use Only—Bank/ABA Number: __________________________________________ Account Information – Form for Account 2 Complete only this form for Account 1 if you want all of your pay deposited into a single account.If you want your pay per pay period deposited into two accounts, complete both this form for Account 1 and the form for Account 2. Account Type: Checking Savings (Select one) Name of Financial Institution:____________________________________________________ Address of Financial Institution:__________________________________________________ Street Address ___________________________________________________ City, State, and Zip Code Telephone Number for Financial Institution: _________________________________________ Percentage or Amount per Pay Period to Deposit for this Account: __________________________ (examples: 100%; $350) (Use when pay is split between two accounts) Confirm Account 1: __________________________ ______________________________ Routing Number Account Number Company Use Only—Bank/ABA Number: __________________________________________
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