*Must have a Bank DD Form or Voided Check

Authorization for Direct Deposit/Paycardl
Direct Deposit is a program in which your pay is automatically deposited into your Global Cash Card and/or Checking/Savings
account(s) and is available to you on the morning of payday. Complete the required information below and select an option. Please
note that if no option is selected, you will automatically be enrolled in the Global Cash Card program.
You can now enjoy the benefits of direct deposit without having to deal with a bank. Sign up for an Global Cash Card today and get
immediate access to your funds on the morning of payday. You’ll be able to withdraw cash from any Plus® ATM. Everyone is eligible to
participate.
Global Cash Card Benefits:

Eliminates the costs and time associated with picking up checks on payday or waiting for the check to arrive in the mail.

No waiting in long lines at the bank.

Provides immediate access to funds on payday.

Eliminates the chance of checks being stolen or lost in the mail and having to wait for replacement check.

Avoids UPS delivery delays.
Name:
First
___ ___ ___ ___ ___ ___ ___ ___ ___
Middle Int
____________
Last
___ ___ ___ ___ ___ ___ ___ ___ ___
DOB: mm/dd/yy _____________________
Address:
Street
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
City
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
State
___ ___
Zip Code
___ ___ ___ ___ ___
Home Phone
___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Email Address
__ __ __ __ __ __ __ __ __ ___ ___ ___ ___
Employee ID # _____________________
( HT Staffing Rep will fill in)
SSN: ____________________________
( HT Staffing Rep will fill in)
Global Cash Card (Account number ___6275-3104- 00 __ __ - __ __ __ __ __ )
ABA Routing # _122242597
* Bank Name______________________________________ Account Type: Checking
Savings
Transit Routing No. ___ ___ ___ ___ ___ ___ ___ ___ ___ (Nine digit bank ID located on bottom left of check)
Bank Account No. ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
(up to 17 characters allowed, including dashes)
Net Pay: _____
(Check  if full amount of pay)
OR
Deposit Amount: $_________________
($ Amount if partial amount of net pay)
*Must have a Bank DD Form or Voided Check
I authorize HT Staffing to initiate credit entries and if necessary, to initiate any actions to reverse or correct an erroneous credit entry to my pay card account at First
Regional Bank, for the purpose of automatically depositing funds into my account.
I understand that this authorization replaces any previous authorization and will remain in full force and effect until I have filed a new authorization, until revoked by
me in writing or upon termination of my employment with HT Staffing.
________________________________________________________
_________________________
Employee’s Signature
Date