SCHIERL COMPANIES



TEAM SCHIERL COMPANIES AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS (CREDITS)

I hereby authorize Team Schierl Companies (hereinafter called Company), to initiate credit entries to my account at the financial institution/s (hereinafter called Depository) indicated below. In the event that Company deposits funds erroneously into my account, I authorize Company to debit my account for an amount not to exceed the original amount of the erroneous credit. This authorization is to remain in full force and effect until Company and Depository have received written notice from me of its termination in such time and in such manner as to afford Company and Depository reasonable opportunity to act on it.

____________________________ ___________________________ _______ ___________________ ______________

Associate’s Name (please print) Associate’s Signature Date Location Associate ID #

You may choose up to three accounts – one account must be for either the entire net amount or the remaining amount owed to you.

ACCOUNT #1 - Required

Account ___ Checking (attach voided check)

Type: ___ Savings (attach voided check)

Choose 1 ___ Amount to Deposit: $_____

OR

___ Full Check Amount:

___________________________________

Depository’s 9 Digit Routing Number

__________________________________

Account Number

___________________________________

Depository Name (Bank, Credit Union, etc)

__________________________________

Depository’s City-State-Zip

__________________________________

Depository’s Phone Number (with area code)

ACCOUNT #2 – Optional

Account ___ Checking (attach voided check)

Type: ___ Savings (attach voided check)

Choose 1 ___Amount to Deposit: $_____

OR

___ Remaining Check Amount:

___________________________________

Depository’s 9 Digit Routing Number

__________________________________

Account Number

___________________________________

Depository Name (Bank, Credit Union, etc)

__________________________________

Depository’s City-State-Zip

__________________________________

Depository’s Phone Number (with area code)

ACCOUNT #3 - Optional

Account ___ Checking (attach voided check)

Type: ___ Savings (attach voided check)

___ Remaining Check Amount:

___________________________________

Depository’s 9 Digit Routing Number

__________________________________

Account Number

___________________________________

Depository Name (Bank, Credit Union, etc)

__________________________________

Depository’s City-State-Zip

__________________________________

Depository’s Phone Number (with area code)

If you currently are using direct deposit and are changing/adding/deleting previous accounts, please indicate what you intend to change:

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