MASTECH, INC.

DIRECT DEPOSIT REQUEST FORM EMPLOYEE INFORMATION

NAME EMP ID# ( ) DAYTIME PHONE NUMBER -

SOCIAL SECURITY NUMBER

CLIENT / LOCATION

EMAIL

DIRECT DEPOSIT INFORMATION

NAME OF FINANCIAL INSTITUTION

ADDRESS

CITY

STATE

ZIP

TRANSIT ROUTING NUMBER DEPOSIT TYPE: FULL DEPOSIT PARTIAL DEPOSIT CHECKING

ACCOUNT NUMBER ACCOUNT TYPE: SAVINGS OTHER $___________CHECKING $___________ SAVINGS $ ___________OTHER

* PLEASE ATTACH A VOIDED CHECK FOR CHECKING ACCOUNTS AND A DEPOSIT SLIP FOR SAVINGS ACCOUNTS. YOUR FIRST PAYCHECK WILL BE A "LIVE" CHECK AS ACCOUNT INFORMATION MUST BE VERIFIED BEFORE DIRECT DEPOSIT CAN BEGIN. ONLY THE FULL AMOUNT OF AN EXPENSE REIMBURSEMENT CHECK MAY BE DEPOSITED.

DIRECT DEPOSIT EXPENSE REIMBURSEMENT INFORMATION

(COMPLETE ONLY IF DIFFERENT THAN ABOVE)

NAME OF FINANCIAL INSTITUTION

ADDRESS

CITY

STATE

ZIP

TRANSIT ROUTING NUMBER ACCOUNT TYPE: CHECKING SAVINGS

ACCOUNT NUMBER

AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT

I HEREBY AUTHORIZE THE DIRECT DEPOSIT OF MY PAY AND/OR EXPENSE REIMBURSEMENT BY MASTECH, INC. INTO THE BANK ACCOUNT(S) OF THE INSTITUTION(S) INDICATED ABOVE. MASTECH WILL MAKE DIRECT DEPOSITS TO MY ACCOUNT IN ACCORDANCE WITH THE PUBLISHED PAYROLL SCHEDULE AND UPON APPROVAL OF MY EXPENSE REPORTS. IN THE EVENT THAT MASTECH ERRONEOUSLY DEPOSITS FUNDS INTO MY ACCOUNT, I AUTHORIZE MASTECH TO DEBIT MY ACCOUNT FOR AN AMOUNT NOT TO EXCEED THE ORIGINAL AMOUNT OF THE CREDIT, OR IF NO LONGER EMPLOYED BY MASTECH, TO REIMBURSE SUCH OVERPAYMENTS DIRECTLY TO MASTECH WITHIN 30 DAYS OF THE OVERPAYMENT(S). I MAY TERMINATE THIS AGREEMENT IN WRITING AT ANY TIME WITH THE UNDERSTANDING THAT TERMINATION OF DIRECT DEPOSITS INTO MY ACCOUNT(S) WILL BECOME EFFECTIVE WITHIN 15 (FIFTEEN) DAYS OF MASTECH RECEIVING WRITTEN NOTIFICATION.

EMPLOYEE SIGNATURE

DATE
REV 7/09