AUTOMATIC PAYROLL DEPOSIT AUTHORIZATION
PLEASE PRINT THIS FORM, COMPLETE INFORMATION AND FAX TO OUR OFFICE
I hereby authorize Saunders Staffing, Inc. or Personnel Pool of Virginia, Inc. to initiate an automatic payroll deposit to the name bank and account identified below. This authorization will remain in effect until otherwise instructed by me, in writing, to Saunders Staffing, Inc. or Personnel Pool of Virginia, Inc.
PLEASE ATTACH A COPY OF A VOIDED CHECK. IF THIS IS A SAVINGS ACCOUNT, PLEASE CHECK WITH BANK FOR CORRECT ROUTING NUMBERS AS THEY MAY DIFFER FROM YOUR DEPOSIT SLIP.
DIRECT DEPOSIT MAY TAKE UP TO THREE WEEKS TO ACTIVATE. IF YOU HAVE ANY QUESTIONS, PLEASE CALL AND ASK FOR OUR PAYROLL ADMINISTRATOR.
NAME:_________________________________________________________________________________
ADDRESS:_________________________________________________________________________________
CITY;_______________________________________________
STATE;__________________
ZIP;__________________
SOCIAL SECURITY NUMBER:____________________________________________________
BANK NAME:__________________________________________________________________________
ADDRESS:_________________________________________________________________________________
CITY;_______________________________________________
STATE;__________________
ZIP;__________________
BANK ROUTING NUMBER;_______________________________________________
BANK ACCOUNT NUMBER;_______________________________________________
TYPE OF ACCOUNT:
CHECKING:_______
SAVINGS:_______
SIGNATURE;_______________________________________________
DATE:__________________
SAUNDERS STAFFING INC.
PERSONNEL POOL OF VA. INC.
400 North Street Bluefield WV. 24701 Ph: 304-325-3369 Fax: 304-325-6817
