The BOOK

Authorization Agreement for Direct Deposit

BANK AND DEPOSIT INFORMATION

Name:______________________________________________________________________________

Bank Name: _________________________________________________________________________

Routing Number: _____________________________________________________________________

Account Number: ____________________________________________________________________

Signature: _______________________________________________ Date: ______________________

I hereby authorize PARKS herein called “COMPANY” to initiate credit entries and to initiate, if necessary,

debit entries and adjustments for any credit entries in error, to my CHECKING or SAVINGS account

indicated below and the depository named below, herein called “DEPOSITORY”, to debit and/or credit the

same to such account.

This authorization is to remain in full force and effect until the COMPANY has received written

notification from me of its termination in such time and in such manner as to afford COMPANY and

DEPOSITORY a reasonable opportunity to act on it.

PLEASE ATTACH A COPY OF A VOIDED CHECK.

Deposit slips do not have the same routing information as a check.

To be completed by the agent, returned to the Office Manager and forwarded to the corporate office.

Date:_________________

Example: