Direct Deposit Authorization Form for Self-Employed Workers of Cleaner and Cleaner Services LLC

Direct Deposit Authorization Form for Self-Employed Workers of Cleaner and Cleaner Services LLC

Self-employment DIRECT Deposit Authorization

Intructions:

Self-Employed: Fill out and return it to your employer.

Contract Company: Save for your files only.

This document must be signed by employees requesting automatic deposit of paychecks and retained on file by the employer. Do not send this form to intuit.

BANK

Checking

Savings

Routing Number

Account Number

Authorizations:

This authorizes CLEANER AND CLEANER SERVICES LLC (the "company") to send credit entries (and appropriate debit and adjustment entries), electronically or by any other commercially acceptable method, to my (our) account(s) indicated below and to other accounts 1 (we) identify in the future (the Account This authorizes the financial institution holding the Account to post all such entries agree that the ACH transactions authorized herein shall comply with all applicable U.S. Law. This 1 authorization will be in effect until the Company receives a written termination notice from me and has a reasonable opportunity to act on it.

Authorized signature

Print Name

Date

Fecha