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.