Authorization for Direct Deposit of Expenses (e1393)
AUTHORIZATION FOR
DIRECT DEPOSIT OF EXPENSES
To enroll in the Direct Deposit program for reimbursement of expenses:
1. Contact your bank or financial institution to verify the following:
• It is an Automatic Clearing House (ACH) member and is therefore able to participate in our program.
• You are submitting the complete account number including hyphens, spaces, etc. required for proper processing of funds.
2. Complete the form below, entering information for only one account: checking or savings. Deposits will not be split between accounts.
3. E-mail this completed authorization to Mailbox Accounts Payable with a copy of a voided check.
Your direct deposit will become effective within three days of receipt of your authorization form. If you change account information after you have enrolled in the program, you will be reimbursed by check while your new account information is being processed, which normally takes two to three days.
Employee Information
I would like to: Enroll in the program Change my account information Be removed from the program
| Legal Name (Last, First, Middle Initial) |Social Security Number |Branch/Dept. Number |
| |xxx–xx– | |
|Name(s) on Account |Account Type |Account Number (plus hyphens, spaces, etc.) |
| |Checking | |
| |– Attach a voided personal check. | |
| |Savings | |
| |– Attach a deposit ticket. | |
|Bank or Financial Institution |Telephone Number |
|Name | – – |
|Address |Routing and Transit No. |
|City | |
|State ZIP Code | |
Employee Authorization
|I authorize Kelly Services, Inc. to reclaim any funds credited in error to the above account by Kelly Services, Inc. |
|I hereby agree that I will not have Kelly Services, Inc. direct deposit any funds due to me in a U.S. bank and then have the entire amount forwarded to a |
|bank account in another country. |
| |
|X Date / / |
If you have any questions, please e-mail Accounts.Payable@.
Please e-mail this form to Accounts.Payable@.
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