Authorization for Direct Deposit
Employee Form
This authorizes;
Mastery Learning Institute (dba Arthur Academy)
to send credit entries (and appropriate debit and adjustment entries), electronically or by
any other commercially accepted method, to my (our) account(s) indicated below and to other accounts
I (we) identify in the future (the "Account"). This authorizes the financial institution holding the Account to post all such
entries.
Account #1
Checking Savings
Employee Bank Name
Bank
Routing # (ABA#) Account #
Percentag
e or Dollar Amount
to be Deposited to this Account
Account #2
Checking Savings
Employee Bank Name
Bank
Routing # (ABA#) Account #
Percentag
e or Dollar Amount
to be Deposited to this Account
This authorization will be in effect until the Company receives a written termination notice from myself and has a
reasonable opportunity to act on it.
Signature
Printed Name
Date
This document must be signed by employees requesting automatic deposit of paychecks and retained on file by the
employer.
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Complete Form and select "Finalize"