Enroll for Direct Deposit: Office where you put in your application:*Please SelectFort Smith IndustrialFort Smith Office & ProfessionalVan BurenFayettevilleSpringdaleRogersClarksvilleRussellvilleConwaySearcyName* First Last Social Security Number: ___________________________________________________Email Address* Street Address P.O. Box or Apt. Number City State / Province / Region ZIP / Postal Code Bank Account InformationBank Name:* Account Type:* Checking Savings Dollar Amount to Deposit:* Please input a dollar amount or Type in "ALL" if you wish for your entire pay check to be deposited in this account.ABA/Routing Number:* Account Number:* Bank Account # 2Bank Name: You did not select ALL, or you entered a dollar amount in Account #1, The remainder of your paycheck will be deposited in Bank Account #2.Account Type:* Checking Savings ABA/Routing Number:* Account Number:* Agreement and Authorization:Additional Information for Direct Deposit:• Typically pay should be automatically deposited into your account(s) within 2 pay periods.• It is your responsibility to notify Payroll of any changes to/closure of your bank account. Failure to notify Payroll may delay issuance of checks.By providing the information requested above and signing below, I hereby elect and consent to receive my wages via direct deposit. In addition, I hereby authorize TEC Staffing Services on its own behalf and on behalf of its direct and Indirect subsidiaries and affiliates to make (electronically or otherwise) all deposit and deposit adjustments involving my pay, including those involving off cycle pay and pay upon discharge, to the account(s) Identified above. and I authorize the bank(s) listed above to accept such deposits and make such adjustments. These authorizations will remain in effect until TEC Staffing Services receives written notice from me terminating my authorization. Signature:___________________________________________________________ Date:____________________
