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    Employee Direct Deposit Authorization

    Choose your method of direct deposit

    Bank / Credit Union

    Bank AB#


    Deduction Amount / Net Pay

    Type of Account

    Please provide a voided check for each checking account listed above.

    And / Or

    Financial Institution Name: MetaBank®

    Routing Number: 124085244

    Direct Deposit Account Number: 353

    To be assigned and entered by PRIORITY CARE STAFFING, LLC.

    Deduction Amount / Net Pay

    Rapid Card

    The rapid! PayCard® MasterCard Card is issued by MetaBank®, Member FDIC, pursuant to a license by MasterCard International Incorporated. Prepaid card can be used wherever Debit MasterCard is accepted. MasterCard is a registered trademark of MasterCard International Incorporated.

    Important Information for opening a Card account: To help the federal government fight the funding of terrorism and money laundering activities, the USA PATRIOT Act requires all financial institutions and their third parties to obtain, verify, and record information that identifies each person who opens a Card account. What this means for you: When you open a Card account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.

    I authorize PRIORITY CARE STAFFING, LLC. to withhold the indicated amount(s), if available, from my pay, and deposit directly into the accoun(s) shown and/or I hereby authorize PRIORITY CARE STAFFING, LLC. to assign a rapid! PayCard and initiate credit entries and any correcting entries to my assigned rapid! PayCard account. The direct deposit(s) will be made on each payday, unless I notify PRIORITY CARE STAFFING, LLC. in writing of my intent to cancel. Upon PRIORITY CARE STAFFING, LLC.'s receipt of a request to cancel a direct deposit authorization, it shall become effective after a reasonable opportunity to act upon it.

    In the event funds are deposited erroneously into my account, I authorize PRIORITY CARE STAFFING, LLC. to debit my account(s) not to exceed the original amount of the credit.

    I understand that PRIORITY CARE STAFFING, LLC. reserves the right to refuse any direct deposit request. I also understand that all direct deposits are made through the Automated Clearing House (ACH), and that funds availability is subject to the terms and limitations of the ACH as well as my financial institution.

    Note: If sending this form electronically, please type your initials and the last 4 digits of your social security number in the signature field. If sending or faxing a paper copy, please print out or sign your name(s) in the signature box.

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