AUTHORIZATION FOR AUTOMATIC DEPOSIT SRE CULINARY EQUIPMENT AND SUPPLIES
Employee Information: Employee Name:
Social Security #:
Address:
City, State, Zip:
Home Phone:
I hereby authorize SRE Culinary to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries in error to my account indicated below and the Depository named below to credit and/or debit the same said account.
This authority is to remain in full force and effect until SRE Culinary has received written notification from me of its termination and in such manner as to afford SRE Culinary and Depository a reasonable opportunity to act on it.
Signature:
Date:
Employee Bank information: (Please attach a voided check or savings account ticket so that we can insure the correct account information is properly recorded.) Bank #1 Bank Name:
Bank Address:
City, State, Zip:
Routing/Transit No.:
Account Number:
This is a:
Checking Account
Amount for this account:
$
or
Savings Account
%
Bank #2 Bank Name:
Bank Address:
City, State, Zip:
Routing/Transit No.:
Account Number:
This is a:
Amount for this account:
Checking Account
$
or
Savings Account
%