This Authorization Form is intended to record your election regarding the disposition of monies eamed in connection with your employment, including, without limitation, amounts attributable to fringe benefit obligations under applicable prevailing wage laws, including the Davis-Bacon Act and any related state or local statutes. By executing this Authorization Form, you hereby appoint and authorize NeuBridg, Inc., together with your employer, to act as your agent for the limited purpose of transmitting, receiving. and updating your banking and financial institution information, and to update your employee records based upon such information as provided. You acknowledge and agree that you are directing NeuBridg, Inc. and its third-party administrator (collectively, "NeuBridg") to add, modify, or otherwise maintain your financial institution information on file. You further expressly authorize your employer to transmit your banking information to NeuBridg, including via census or similar reporting mechanisms. You acknowledge and agree that such information shall be used solely for purposes of facilitating direct deposit, payroll funding, and benefit plan administration, and that NeuBridg shall maintain the confidentiality of such information in accordance with all applicable privacy laws and regulations. You hereby knowingly and voluntarily elect to participate in the Lifestyle Savings Account (LSA) plan and direct that all net proceeds payable to you thereunder be deposited into the financial institution account designated by you. You expressly acknowledge and agree that all amounts allocated to you under this program constitute wages, are fully vested, and shall be treated as taxable and reportable income in accordance with applicable law. Nothing herein shall be construed to alter, re-characterize, or otherwise modify the treatment of such amounts as wages. You represent and warrant that you are the lawful owner and authorized signatory of the designated financial institution account, and that all banking information provided is true, accurate, and complete. You agree to promptly notify your employer and NeuBridg of any changes to such information. You further acknowledge that any delay, misdirection, or failure of payment resulting from inaccurate, incomplete, or outdated information provided by you shall be your sole responsibility. You hereby consent to the electronic delivery of wage statements and related communications in lieu of paper copies. You further acknowledge that you are responsible for reviewing the then-current NeuBridg Fee Schedule applicable to the LSA program. In the event NeuBridg incurs any costs, fees, or charges as a result of inaccurate or incomplete information provided by you, you hereby authorize NeuBridg to debit such amounts in accordance with the applicable fee schedule. You hereby authorize and instruct NeuBridg to establish, update, or modify your account information, including but not limited to account number, routing number, and account type, and to utilize such information for all eligible deposits associated with any NeuBridg-administered accounts in your name. In the event you do not maintain a banking relationship, you acknowledge that a debit card may be issued through a NeuBridg partner for purposes of receiving deposits. For individuals currently receiving distributions via a NeuBridg-issued debit card, you acknowledge and agree that, upon receipt and processing of this Authorization Form, all future distributions shall be directed to the financial institution account designated herein. In the absence of a completed Authorization Form, deposits shall continue to be made to the debit card on file. You further acknowledge that any existing balances on a debit card will not be transferred to your designated financial institution account. This Authorization shall become effective as of the date specified herein, provided that NeuBridg receives this form prior to such effective date. In the absence of a specified effective date, the effective date shall be the date of receipt by NeuBridg. This Authorization shall remain in full force and effect until revoked or modified by submission of a subsequent authorization form. In the event of any discrepancy or conflict, the most recent Authorization Form received by NeuBridg shall control. You agree to allow a reasonable processing period for implementation of any changes and hereby release, indemnify, and hold harmless your employer, NeuBridg, and their respective agents, employees, and affiliates from and against any and all claims, damages, or liabilities arising out of or related to deposits made to a previously authorized account or to any account or address on file prior to the effective processing of any requested changes.