Name:  

Address:  

Name of Bank:  

Account #:  

9-Digit Routing #:  

Type of Account:  

ConnectMyBiz is hereby authorized to directly deposit my pay to the account listed above. This authorization will remain in effect until I modify or cancel it in writing to [email protected].

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DATE:

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Your email address

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

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Signature Certificate

Document name: Direct Deposit

Unique Document ID: 7598580a25f50e429fa06817d4344afba6972771

Build. Track. Sign Contracts.

Timestamp	Audit
May 24, 2023 1:30 pm CST	Direct Deposit Uploaded by Scott Leonard - [email protected] IP 64.82.132.117

This audit trail report provides a detailed record of the online activity and events recorded for this document.

https://connectmybiz.net/

Audit Trail Serial# 4193a5007e806ae489f394bf904afbc8