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Direct Deposit Authorization Form

We are pleased to be able to offer you a new payday convenience—Direct Deposit. Now you can have your paycheck automatically deposited in your checking or savings account on payday. And you don’t have to change your present banking relationship to take advantage of this service.

Direct Deposit will help you in many ways

  • It saves you trips to your financial institution.
  • It saves you time in depositing checks— no long payday lines to wait in.
  • It eliminates the possibility of lost, stolen or forged checks.
  • Your money is deposited faster— reduces the possibility of overdrafts.
  • You get your money deposited into your account even if you’re on vacation or away from the office on business or illness.

Here’s how Direct Deposit works:

On payday you will receive an earnings statement showing gross salary, taxes, other deductions, and net pay. Your money will already have been deposited in your account. The amount of the deposit will appear on your bank statement. We believe you will like the added convenience of having your net pay automatically deposited for you.

Direct Deposit is safe, convenient and easy. To take advantage of this service, complete the attached authorization form and return it to the Payroll Department

The authorization form, which is provided on the reverse side, gives your employer the authority to deposit your pay to your account. Simply complete the form in order to take advantage of Direct Deposit

All you need to do is:

  1. Mark the box before type of account to indicate whether your pay will be deposited in your checking or savings account.
  2. Fill in your name, the name andlocation of your financial institution, and today’s date.
  3. Attach a voided check for verification of all financial institution information. If you are unable to attach the voided check, please fill in your account number.
NOTE: Be sure to sign the form!

 

Please complete the information below and return to payroll.

I authorize FINANCIAL LOCK INC.to initiate electronic credit entries each pay period, and if necessary, debit entries and adjustments for any credit entries in error to my:

I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. This authority will remain in effect until I have cancelled it in writing.

Date
FINANCIAL INSTITUTION NAME (PLEASE PRINT)
ACCOUNT NUMBER AT FINANCIAL INSTITUTION
FINANCIAL INSTITUTION ROUTING NUMBER
FINANCIAL INSTITUTION CITY AND STATE
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By checking this box, I have read and understand, and agree to the Agent Terms and Conditions