Authorization for Direct Deposit of Payroll

I hereby authorize Summit Technical Services, Inc to deposit my pay each payday into the account(s) listed below. This agreement will remain in effect until I give written notice to terminate it or until my employer notifies me that this service has been terminated. In the event my employer deposits funds erroneously into my account, I authorize my employer to debit my account for an amount not to exceed the original amount of the erroneous credit. I understand that if I enter incorrect bank account information onto this form that Summit will not be notified of my error until at least three business days after payroll has been issued, therefore delaying my paycheck for at least four business days after the original date of issue.

Name: _______________________________________ SS# ____________________

Signature: ____________________________________ Date: __________________

IMPORTANT: Please verify Transit Routing # and Account # directly with your bank.

Deposit #1

Bank: _________________________________________ Branch: __________________

Bank Telephone # ____________________ Deposit to: ______Savings _____Checking

Transit Routing # ___________________________________

Account # _________________________________________

Amount of Deposit: $__________

Deposit #2

Bank: _________________________________________ Branch: __________________

Bank Telephone # ____________________ Deposit to: ______Savings _____Checking

Transit Routing # ___________________________________

Account # _________________________________________

Amount of Deposit: $__________

*If you require additional deposits please submit additional Direct Deposit Form