Important! Please read and sign before completing and submitting.
I herby authorize BenefitMall to deposit any amounts owed me as instructed by my employer by initiating credit entries to my accounts at the financial institutions (hereinafter "Bank") indicated on this form. Further, I authorize Bank to accept and to credit any credit entries indicated by BenefitMall to my accounts. In the event that Compupay deposits funds erroneously into my account, I authorities BenefitMall to debit my accounts for an amount not to exceed the original amount of the erroneous credit accounts. I further authorize BenefitMall to debit my account in the event my employer does not provide funds to cover credits initiated by BenefitMall.
This authorization is to remain in full force and effect until BenefitMall and Bank have received written notice from me of its termination in such time and in such manner as to afford BenefitMall and Bank reasonable opportunity to act on it.