DEPOSIT AUTHORIZATION AGREEMENT
Originating Company Name: Infosystems Technology, Inc.
Company Tax ID Number: 56-2040389
I (we) hereby authorize Infosystems Technology, Inc., hereinafter called ITI, to
initiate credit entries or such adjusting entries, either debit or credit which are
necessary for corrections, to my (our) _____ checking ______savings account
indicated below and the depository name below, hereinafter called DEPOSITORY,
to credit (or debit) the same to such account.
Name in which account is listed: ___________________________________
Employee’s City, State, Zip: ________________________________________
Bank Name/Branch: ______________________________________________
Bank Transit/ABA Number: ________________________________________
Account Number: ________________________________________________
This authority is to remain in full force and affect until ITI has received written
notification from me (or either of us) of its termination in such time and in such
manner as to afford ITI a reasonable opportunity to act on it.
Social Security/ID Number: _______________________________________
Signature and Date: _____________________________________________
Second Party Signature and Date: _________________________________
Please attach a voided check or deposit slip from your account to this form.
NOTE: If account is a joint account both parties must sign this form.
NOTE: Please call your bank to verify your ABA #. The ABA# printed on your
check or deposit slip may not be correct for Direct Deposit transactions.
ITI, 2200 Gateway Centre Blvd., Ste. 207, Morrisville, NC 27560 Phone (919) 459-4000 Fax (919) 459-4001