Direct Deposit e-form (ND)

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)
Name of Bank
Bank Routing #
VERIFY IF CORRECT
Re-enter Bank Routing #
VERIFY IF CORRECT
Bank Account #
VERIFY IF CORRECT
Re-enter Bank Account #
VERIFY IF CORRECT
Term of Authorization
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
Clear
Employee Name
First NameLast Name
Employee Phone Number
Area CodePhone Number
Email
example@example.com
Authorization Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Bank Check / Bank info form
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Authorization For Direct Deposit