Direct Deposit Form

Company Name and/or Client Number: Williams Logistics LLC

Employee Name

First NameLast Name

COMPLETE TO ENROLL / ADD / CHANGE BANK ACCOUNTS

CheckingSavings

Account Holders Name

First NameLast Name

Routing/Transit Number

Checking/Savings Account Number

Financial Institution (Bank) Name

CONFIRMATION STATEMENT

I authorized my employer/company to deposit my earnings into the bank account(s) specified above and, if necessary, to electronically debit my account to correct and erroneous entries. I certify my account(s) allow these transactions. Furthermore, I certify that the above-listed account number accurately reflects my intended receiving account. I agree that direct deposit transactions I authorize comply with all applicable laws. My signature below indicates that I m agreeing that I am either the account holder or have the authority of the account holder to authorize my employer/company to make direct deposits into the named account. I understand that this authoritarian will remain in full force and effect until I notify Company in writing that I wish to revoke my authorization. I understand that the company requires at least 5 business days prior notice to cancel this authorization.

Signature

Date

I confirm that the above-named employee/worker has added or changed a bank account for direct deposit transactions processed by Paychex Inc. I have reviewed the information provided and it is accurate to the best of my knowledge. My signature below indicates that I have the authority to execute the document on behalf of the client.

Employer/Company Representative Printed Name: Williams Logistics LLC