Download Direct Deposit Authorization Agreement

Direct Deposit Authorization Agreement
I hereby authorize my employer, SkyBridge, Inc. (“Company”), to deposit any amounts owed to me by initiating credit entries to my
accounts(s) at the financial institution (“Bank”) indicated below. Further, I authorize the Bank to accept and to credit any credit
entries indicated by the Company to my account. In the event the Company deposits funds erroneously into my account, I authorize
the Company to debit my account for an amount not to exceed the original amount of the erroneous credit.
Employee Information
PRINT Employee Name: ____________________________________________ SSN:__________________________
 Initial Enrollment - OR -  Change
Bank Information
You have the opportunity to deposit your funds in up (2) checking accounts and (2) savings accounts. Please specify either specific
dollar amounts or BALANCE for deposit. BALANCE of net pay must be elected for at least one account.
#1 Bank Name: _____________________________________________________________
 Checking Account (attach voided check) -OR-  Savings Account (attach deposit slip)
Routing Number:_____________________________________________________________
Account Number:_____________________________________________________________
I wish to deposit:
 $___________________
-OR-
 BALANCE
#2 Bank Name: _____________________________________________________________
 Checking Account (attach voided check) -OR-  Savings Account (attach deposit slip)
Routing Number:_____________________________________________________________
Account Number:_____________________________________________________________
I wish to deposit:
 $___________________
-OR-
 BALANCE
#3 Bank Name: _____________________________________________________________
 Checking Account (attach voided check) -OR-  Savings Account (attach deposit slip)
Routing Number:_____________________________________________________________
Account Number:_____________________________________________________________
I wish to deposit:
 $___________________
-OR-
 BALANCE
#4 Bank Name: _____________________________________________________________
 Checking Account (attach voided check) -OR-  Savings Account (attach deposit slip)
Routing Number:_____________________________________________________________
Account Number:_____________________________________________________________
I wish to deposit:
 $___________________
-OR-
 BALANCE
Authorization
This authorization is to remain in full force and effect until the Company and the Bank have received notice from me of its termination
in such way and in such manner as to afford the Company and the Bank a reasonable opportunity to act on it.
Employee Signature__________________________________________________
Date____________________