Authorization for Direct Deposit

Account account number

I authorize Roofmeador Services, Inc. to deposit my pay automatically to the account(s) indicated below and, if necessary, 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 Roodmeadow Services, Inc. a reasonable opportunity to act on it.

Name on Bank Account *

Bank account number *

Account Type *

Checking
Savings

Bank Routing Number *

Multiple Choice

DEPOSIT ENTIRE AMOUNT INTO ABOVE BANK ACCOUNT
DEPOSIT A PORTION INTO THIS ACCOUNT & THE REST TO A 2nd Account

*Note: Split payments are not available for contractors.

Name on 2nd bank account

2nd Bank Routing Number

Important: Please attach a voided check for each bank account to which funds should be deposited.

Employee/Contractor Signature *

Clear Signature

Date *

RSI-DD

Authorization for Direct Deposit