Servant Anchor Security | Authorization for Direct Deposit

This form authorizes Servant Anchor Security Services to deposit my wages/salary into the bank accounts specified below:

Employee Name(Required)

First Last

Type of account(Required)

Checking

Savings

Bank account number(Required)

Routing/Transit Number(Required)

Bank Name & Address(Required)

Deposit Amount(Required)

100% of Net

Specific Amount

Enter Specific Amount Below:(Required)

Type of Account for remaining amount(Required)

Checking

Savings

Enter remainder of net after specific amount below:(Required)

Please attach one of the follow: Voided check with name imprinted (No started checks) or Bank Letter/Specification sheet (signature of local bank representative must be included).(Required)

Max. file size: 256 MB.

My initials confirms that I am the account holder, and as the account holder, authorize Servant Anchor Security Services to make direct deposits into the specified account(s). This authorization will be in effect until the Servant Anchor Security Services payroll department receives a written termination notice from me and has had reasonable opportunity to process the request.

Please Initial Below(Required)

Date(Required)

Please answer security question: 5+8 =?(Required)

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