Transcription of Authorization for Direct Deposits for Contractors
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Name _____ Agent Number _____ Branch Number _____I hereby authorize and instruct Liberty National Life Insurance Company, (the Company ), to deposit the amount of each of my commission payments directly into my checking and / or savings account as indicated below in the Deposit Instructions and to make any such withdrawals directly from my account or accounts as are necessary to correct any incorrect deposit by the Company under this further hereby authorize and instruct the financial institution named below (the Institution ) to accept such automatic Deposits to or withdrawals from my account or accounts by the Company and to cause my account or accounts to be automatically credited or debited (as the case may be) in the amount of such Deposits or withdrawals by the Company without any responsibility for the correctness of
Name _____ Agent Number _____ Branch Number _____ I hereby authorize and instruct Liberty National Life Insurance Company, (the “Company”), to deposit the amount of each of my commission payments directly into my checking and / or savings account as indicated below in the Deposit Instructions and to make
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5: HIRE-ABOVE-MINIMUM, 5: hire-above-minimum authorization, Authorization, Electronic Funds Transfer (EFT) Authorization, MLGW AutoPay DIRECT DEBIT AUTHORIZATION, MLGW AutoPay DIRECT DEBIT AUTHORIZATION AGREEMENT, Reporting Agent Authorization, Internal Revenue Service, AUTHORIZATION TO RELEASE CONFIDENTIAL, AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION, Independent Travel Agent: PIN: Agent