Authorization for Direct Deposit
Name
*
First Name
Last Name
By checking the box below, I authorize Mantra Fitness to deposit my pay automatically to the account(s) indicated below and, if neccessary, to adjust or reverse a deposit for any payroll entry made to my account in error. This authorization will remain in effect until I cancel it in writing and in such time as to afford Mantra Fitness a reasonable opportunity to act on it.
*
I Agree
Name on Bank Account
*
Bank Account Number
*
Routing Number
*
Type of Account
*
Checking
Savings
Please attach an image of a voided check
Browse Files
Cancel
of
Amount to this Account
*
Entire Paycheck
Other
Balance of pay to (if paycheck is to be split):
Manual (Paper Check)
Second Account Described Below
Name on Second Bank Account
Second Bank Account Number
Second Routing Number
Type of Account
Checking
Savings
Please attach an image of a voided check
Browse Files
Cancel
of
Employee/Contractor Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: