Common Contracts
1 similar Direct Deposit Authorization contracts
Direct Deposit Authorization FormDirect Deposit Authorization • March 19th, 2019
Enjoy the convenience of direct deposit by having future payments electronically deposited directly into your bank account. We will email your commission statement to the below indicated email address. I agree to accept payments through electronic funds transfer (EFT) and ensure that you can rely exclusively on the information supplied through this form. This agreement applies to and amends all existing agreements with the entity(ies) checked below. I hereby authorize the entity(ies) noted below to initiate credit entries to and/or debit entries from the financial institution and the account named below.Delta Dental of Virginia Stryden, Inc. Both Stryden, Inc. and Delta Dental of Virginia Agent Information Payee Name Payee Tax ID Address Phone Email Financial Institution Information Checking Account Number Bank Transit/ABA Number Financial Institution Name City State I understand this arrangement will be in effect until I provide notice in writing that I no longer wish to receive funds
