Direct Deposit Authorization Agreement Form

Company Name: Cahuilla Band of Indians

I (We) hereby authorize the company listed above to make payments of any amounts owing to me (either us) by initiating credit entries to my (our) account indicted in the bank named below, herein called Bank, and I (we) authorize and request Bank to accept any credit entries initiated by Company to such account and to credit the same such account without responsibility for the correctness thereof.

I (We) also authorize and request Company to effect repayment to Company for any amount owed it because of a prior erroneous credit initiated to my (our) account if prior to initiation of the correcting entry, the Company has notified me of the correction and reason therefore; and, the correction entry is transmitted in such time as to be delivered or make available to Bank before midnight of the tenth day next following settlement for the erroneous entry.

It is understood that this agreement may be terminated by either party at any time by written notification to Company or Bank. Any such notification to Company shall be effective only with respect to entries initiated by Company after receipt of such notification and a reasonable opportunity to act on it. Any such notification to Bank shall be effective only with respect to entries credited to my (our) account by Bank after receipt of such notification and a reasonable time to act on it.

I (We) recognize, acknowledge and accept that this service is being provided for my (our) convenience. As such, I (We) agree to hold the Company, computer payroll company, each participation Bank and NACHA harmless from any claim incident to the operation of this plan, arising from any act of omission by the Company and/or computer payroll company and their employees, including without limitation any claim based on alleged loss as a result of non-credit of any deposit, and any claim which be made by any depositor as a result of the rejection of any of his debts because of insufficient funds arising from failure to credit deposits to my (our) account.

Initials

Two Deposit Options

Deposit my entire net pay amount to my(Required)

You also have the option to split checks into various accounts:

of my net pay to
of my net pay to

YOU MUST ATTACH A VOIDED BLANK CHECK FOR CHECKING ACCOUNT(S) AND A STATEMENT FROM THE BANK WITH YOUR SAVING ACCOUNT(S) INFORMATION.

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PLEASE NOTE: Changes take 30 days to take effect.

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