Pay Options: Direct Deposit Form (e1993)



-47625-307975PAY OPTIONS: DIRECT DEPOSITKelly Services, Inc. and its subsidiaries (“Kelly”) offer two options to receive your pay: Direct Deposit or the Money Network? Service. To understand Money Network?, ask your Kelly Representative to supply you with the Pay Options: Money Network Service Form (e1991).DIRECT DEPOSIT: Kelly will disburse all of my net pay as selected below (“Direct Deposit”) into the account (the “Account”) at the financial institution with the routing and account number and account type (collectively, “Account Information”) I have provided to Kelly by completing and submitting the Direct Deposit Enrollment Information below.i was given the option to select either Direct Deposit or Money Network Service as my preferred method of pay (CA, CT, GA, NH, and NY Only: I was also given the option for an employer-issued paper pay check):(REQUIRED - check the box. By checking the box, I am agreeing with this statement.) FORMCHECKBOX By completing this form and submitting this document, I authorize Kelly to disburse my pay via Direct Deposit. In case of erroneous credit of funds to which I am not entitled, I further authorize Kelly to debit the Account. I understand that I can change my pay selection at any time in the future by submitting a new Employee Pay Selection Form and other required information, according to Kelly procedure (subject to the time it takes Kelly to implement the change). My election will remain in effect unless Kelly and/or Program Manager cancels this arrangement.Direct Deposit Enrollment InformationComplete all sections of the form below. Enter information for only one account: checking or savings. (Deposits cannot be split between accounts.)For Direct Deposit to a checking account, attach either a voided personal check or bank letter from your financial institution.Return the completed authorization form to your Kelly Representative. Please note that it can take up to three pay periods for Direct Deposit to begin. Until then, you will be paid by check. Once your enrollment is complete, your pay will be deposited directly into your account. First NameMiddle InitialLast NameSocial Security/Social Ins. No.Kelly Branch No. (obtain from Kelly Rep)Name(s) on AccountAccount Type: FORMCHECKBOX Checking FORMCHECKBOX SavingsBank Name/AddressCity, State/ProvinceZIP/Postal CodeBank Routing No.(U.S. ONLY)Bank No.(CANADA ONLY)Transit No.(CANADA ONLY)Account No.With this Direct Deposit enrollment form, I am attaching either (not required if using eRegistration): □ Voided Check (attach voided check below) □ Bank Letter (Include with this enrollment form as a separate page)24765076200ATTACH VOIDED CHECK HERE(DO NOT ATTACH DEPOSIT SLIP)00ATTACH VOIDED CHECK HERE(DO NOT ATTACH DEPOSIT SLIP) ................
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