US Direct Deposit Authorization Form (English)

Direct Deposit Authorization Form - US
Personal Information
Brand Affiliate ID #*
ex. US123456
Applicant #1 Full Name*

First NameLast Name
Applicant #2 Full Name

First NameLast Name
Social Security Number or Tax ID Number*
ex: ###-##-#### or ##-##-####
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Bank Account Information
START depositing credit balance funds due to me from bonuses into my checking or savings account pursuant to the the financial institution information provided below. (Commission statement may be viewed online in My Office > Volumes and Genealogy.)CHANGE my direct deposit routing and/or account number according to the information in provided below.
Bank Account Information
Name on Bank Account*
Bank Account Routing Number (ABA)*
Bank Account Number*
CheckingSavings
Bank Name*
Bank Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Please verify all information with your bank to ensure accuracy. Name on bank account must match the name on Brand Affiliate's account, this includes business names.

Please note - $1 processing fee for each electronic deposit requested outside of the weekly schedule.
Direct Deposit Requires the Signature of all Applicants on Brand Affiliate's Account

I CERTIFY THAT I HAVE AN ACCOUNT AT THE FINANCIAL INSTITUTION INDICATED ABOVE AND THAT THE INFORMATION I HAVE PROVIDED IS TRUE AND CORRECT.
Principle Partner Signature*

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Secondary Partner Signature

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Direct Deposit Authorization Form - US

Personal Information

Bank Account Information

Bank Account Information

Please verify all information with your bank to ensure accuracy. Name on bank account must match the name on Brand Affiliate's account, this includes business names.

Please note - $1 processing fee for each electronic deposit requested outside of the weekly schedule.

Direct Deposit Requires the Signature of all Applicants on Brand Affiliate's Account