Pay Selection Authorization

Agreement
JBD

is proud to offer one option for receiving your pay: Direct Deposit. Pleas

box for your selection below, and fill out all required fields in that section.

To authorize direct deposit, please follow these instructions

1.
2.
3.
4.

Provide your name and Social Security Number in the spaces below.
Check the box indicating where you want your pay deposited checking or savings.
Complete the financial institution information for your account.
Electronically Sign and date the form.

Full Name: Mykel S Lockhart

SSN: 654030570

Contact Number: 8432748370

Store Number: 1901

Option 1 - I wish to be paid through Direct Deposit

Amount to deposit: Ne
Account 1 Type:

Checking Savings

Amount: 200
Routing Number:

Account Number: 157222

253075303

Re-Enter Routing Numb

Re-Enter Account Number: 157222

253075303

Bank Name:
sharonview federal credit union

Digitally Signed By: Mykel Lockhart

Date: Mar-14-2016 5:47:31 PM EDT

Employee Signature

03/14/2016
Date