Direct Deposit e-form

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.
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.
Name of Bank *
Routing number: *
Bank account type: *

Checking Savings
Bank Account # *
VERIFY IF CORRECT
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Employee Authorization Signature *

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Employee Name *

First Name Last Name
Employee Phone Number *

Area Code Phone Number
Authorization Date *

Month Day Year
Date
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