Direct Deposit Agreement Form

Direct Deposit Agreement Form
Authorization Agreement
I hereby authorize Sprung Services, Inc. to initiate automatic deposits to my account at the financial institution named below. I also authorize Sprung Services, Inc. to make withdrawals from this account in the event that a credit entry is made in error.

Further, I agree not to hold Sprung Services, Inc. responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account.

This agreement will remain in effect until Sprung Services, Inc. receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to the Payroll Department.
Account Information
Name of Financial Institution:
Routing Number:
Account Number:
Account Type:
Account Holder Name:

First NameLast Name
Signature
Signature

Clear
Date Signed:

MonthDayYear
Date
Should be Empty:

Authorization Agreement