Example: quiz answers

Authorization for Direct Deposits for Contractors

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 any such deposit or account institution:Institution _____Institution Address _____ (City) (State) (ZIP)Deposit Instructions (Please check appropriate boxes) Deposit the full amount of my net pay to my account number Deposit $ of my net pay to my account number and the remainder of my net pay to my account number You must be an account holder for a

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 …

Tags:

  Direct, Authorization, Deposits, Contractor, Authorization for direct deposits for contractors

Information

Domain:

Source:

Link to this page:

Please notify us if you found a problem with this document:

Other abuse

Transcription of Authorization for Direct Deposits for Contractors

1 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 any such deposit or account institution:Institution _____Institution Address _____ (City) (State) (ZIP)Deposit Instructions (Please check appropriate boxes) Deposit the full amount of my net pay to my account number Deposit $ of my net pay to my account number and the remainder of my net pay to my account number You must be an account holder for any account to which you wish to make a Direct deposit.

2 Note that if the amount of your net pay is less than the amount you elected for deposit to the first account, all of your net pay will be deposited to the second account. Always check your earnings statement for information concerning your net pay and the account(s) to which it has been your secondary account is in a different institution: (Otherwise write Same )Institution _____Institution Address _____ (City) (State) (ZIP) Please cancel my automatic payroll deposit(s).Forward this completed form and the voided check to Attach a voided check for the account or accounts to which such automatic Deposits are to be made. I understand that I can cancel this Authorization at any time. To cancel, I must give written notice to both the Company and the Institution. My cancellation will become effective as to the company when the Company receives my notice of cancellation and has had a reasonable period of time upon which to act on it.

3 Any automatic Deposits to or withdrawals from my account or accounts by the Company up until that time will be authorized by this Authorization . My cancellation of this Authorization will become effective as to the Institution when the Institution receives my notice of cancellation and has had a reasonable period of time upon which to act on it. Any automatic credits or debits made to my account or accounts by the Institution up until that time will be authorized by this further understand that all automatic Deposits and credits to or withdrawals and debits from my account or accounts under this Authorization will be subject to all rules, regulations, agreements and disclosure statements of the Company and the Institution governing accounts and preauthorized transfers to and from hereby state that I received a completed copy of this Authorization on the date I signed the Name: _____ Signature: _____ Date: _____Authorization for Direct Deposits for Contractorsp Checking p Savingsp Checking p Savingsp Checking p SavingsPLEASE RETAIN COPY FOR YOUR RECORDSR-2535, Ed.

4 12-2012 LNL1324 1212


Related search queries