Direct Deposit Authorization Form

Direct Deposit Authorization Form
Store Number*
Email
Date*

MonthDayYear
Date
Team Member's Legal Name*
YesNo
Full name on the account*
Enter your email below. You will be notified when the change has been made.
example@example.com
9 Digit Routing Number*
Full Account Number*
CheckingSavings
Please make sure to read this before proceeding*
Make sure the picture of the document is facing the correct direction. Make sure that everything is clear and readable in the picture.
Voided check or letter from your bank's website with routing and account number*

Cancelof
Legal Notice:*
By digitally signing the document below I hereby authorize New River Vally Puizza LLC to directly deposit my pay to the account listed above. This authorization will remain in effect until I modify or cancel it in writing.
Signature*

Clear
Should be Empty: