AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT OF PAYROLL

I hereby authorize [Firm Name], hereinafter called COMPANY, to initiate credit entries or debit corrections to my                        Checking                      Savings account indicated below and the financial institution named below to credit the same to such account.

Financial Institution

City                                                                                          State

Bank Transit/ABA Number                                                                   Account Number

This authority to remain in full force and effect until COMPANY has received written notification from me of its termination in such time and in such manner as to afford COMPANY a reasonable opportunity to act on it.

Printed Name                                                                Social Security Number

I authorize the direct deposit transfer amount of                          .  I understand my percentage deduction amount can be changed on a quarterly basis.

                        Signature                                                                                  Date