Nurses Direct - Authorization For Direct Deposit
This authorizes NURSES DIRECT, LLC to send credit entries (and appropriate debit and adjustment entries), electronically or by any other commercially accepted method, to my (our) account(s) indicated below and to other accounts I (we) identify in the future (the "Account"). This authorizes the financial institution holding the account to post all such entries.
Bank Account Type (choose one)
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Checking
Savings
Name of Bank
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Bank Routing #
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VERIFY IF CORRECT
Re-enter Bank Routing #
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VERIFY IF CORRECT
Bank Account #
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VERIFY IF CORRECT
Re-enter Bank Account #
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VERIFY IF CORRECT
This authorization will be in effect until NURSES DIRECT, LLC recieves a written termination notice from myself and has a reasonable opportunity to act on it.
Employee Authorization Signature
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Clear
Employee Name
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First Name
Last Name
Employee Phone Number
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-
Area Code
Phone Number
Authorization Date
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-
Month
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Day
Year
Date
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Bank Check / Bank info form
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