• FOR YOUR FILES ONLY

  • Authorization for Direct Deposit - Employee Form

  • This authorizes XINCON HOME-HEALTHCARE SERVICES INC (the "Company") 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.

    Note: Enter your company name in the blank space above.

    Account#1

    Account #1 Type:                  CHECKING

  • 100% NET PAY
    PERCENTAGE OR DOLLAR AMOUNT TO BE DEPOSITED TO THIS ACCOUNT

     

     

     

     

     

     

    This authorization will be in effect until the Company receives a written termination notice from myself and has a reasonable opportunity to act on it.

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