DIRECT DEPOSIT AGREEMENT
NAME:_________________________ EMPLOYEE #:_______________ DAYTIME PHONE #:_________________
Complete one section: A, B or C
Section A Section B Section C
NEW ENROLLMENT CHANGE EXISTING ENROLLMENT CANCEL EXISTING ENROLLMENT
Primary Checking or Savings Account Primary Checking or Savings Account Primary Checking or Savings Account
Bank Name:____________________ Bank Name:____________________ Bank Name:____________________
Routing #: _____________________ Routing #: _____________________ Routing #: _____________________
Account #: _____________________ Account #: _____________________ Account #: _____________________
100% of remaining net pay 100% of remaining net pay
Secondary Account Secondary Account Secondary Account
Bank Name:____________________ Bank Name:____________________ Bank Name:____________________
Routing #: _____________________ Routing #: _____________________ Routing #: _____________________
Account #: _____________________ Account #: _____________________ Account #: _____________________
% per pay period % per pay period
OR OR
$ per pay period $ per pay period
AUTHORIZATION
I hereby authorize Air Star Computers Inc. to initiate direct deposit payroll credit entries to my account(s) indicated above and the Financial Institution indicated
above to post the same to such account. This authorization is to remain in full force and effect unless and until Air Star Computers Inc. receives prior written notice
of change or cancellation from me. I assume responsibility for the accuracy of all information provided herein.
If funds to which I am not entitled are deposited to my account by Air Star Computers Inc., I hereby authorize Air Star Computers Inc. to direct the bank to return
said funds.
Signature Date
DOCUMENTATION
Attach a permanent voided check, permanent deposit slip (for Savings Accounts without check privileges), or other official bank documentation for verification of
routing and account numbers. (No temporary and/or handwritten information will be accepted.)
Attach the confirmation e-mail from the US Treasury if enrolling for Savings Bonds. You may visit the Payroll Intranet site for more detailed instructions on enrolling
for Savings Bonds.
John Doe 101
123 Main Street
Anywhere, USA Checking
Pay to Order of $ Savings
Dollars
1st Nation Bank
Anywhere, USA
|: 012345678 |: 123456789" 101