AUTOMATIC (DIRECT) DEPOSIT

AUTOMATIC (DIRECT) DEPOSIT & EMAIL CHANGE REQUEST FORM
Name*

First NameLast Name
I, authorize Expediter Services, LLC to initiate credit to my account indicated below at the depository financial institution named below, hereafter called DEPOSITORY. I acknowledge that the origination of the ACH transactions to my account must comply with the provisions of the U.S. law.*

CHECKINGSAVINGS
Type a question*

PERSONALBUSINESS
Depository Bank*
If Applicable, Enter Business Name Here:
Branch*
City*
STATE*
Zip*
Account No*
Routing No*
This authorization is to remain in full force and effect until Expediter Services, LLC has received written notification from the signed below of its termination in such time and in such manner as to afford Expediter Services, LLC and Depository a reasonable opportunity to act on it.
Name*
Truck#*
Date*

MonthDayYear
Date
Email*
example@example.com
Please select your Carrier*
Cell#*
Allow 1-2 weeks after receipt to be effective

NOTE: Please refer to Schedule A for carrier specific pay schedule. Exceptions are when settlement date falls on a holiday. In this situation, it will be deposited the following business day.

have read the above statement and comply. ,
If you have access to the internet, please supply an email address so we can send your statement
example@example.com
If you do not have a front copy of a blank check or direct deposit form then please provide a copy of a recent bank statement.
Please click the image link(s) below to attach an image of your financial document & a copy of your photo CDL or ID card.
File Upload*

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File Upload*

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Signature*

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AUTOMATIC (DIRECT) DEPOSIT & EMAIL CHANGE REQUEST FORM