Common Contracts
1 similar Direct Deposit Authorization Agreement contracts
DIRECT DEPOSIT AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITDirect Deposit Authorization Agreement • March 30th, 2015
This form authorizes the Reimbursement agent to deposit payments directly into the bank account listed below and, if necessary, reverse any incorrect credit entries made in error related to the payments. This agreement will remain in effect until the ELC of Broward receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form. I understand that, for my protection, verbal notications of direct deposit cancellation will result in a stop payment of the reimbursement. The ELC will not issue payment until a written notice of cancellation is provided and verified. I agree to resubmit this form immediately (within one business day) in the event that there are any changes to the bank or bank account, Federal ID, address, or if I decide to stop direct deposit.
