Umpire Direct Deposit

DIRECT DEPOSIT AUTHORIZATION FORM

By submitting this form, I authorize North Jefferson Junior Baseball Association to deposit payment for wages and other compensation directly into my account at the financial institution named below, and if they deem necessary, in their sole discretion initiate adjustments for any transactions credited/debited in error.

This authorization is to remain in full force and effect until I provide written notification of any changes or termination in such time and in such manner as to afford my employer and the Financial Institution reasonable opportunity to act on it. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law.

Full Name (First Last)
Email Address
Cell Phone #
Date of Birth
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Financial Institution Name
Financial Institution Address
Account Holder's Name
Account Type
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Routing Number
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Account Number
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Verification

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