Print or save this form to give to your employer or government benefits provider. Please Add To ‘Account Number 6220054162860 stem Saas ae Routing Number 124071889 Bluebird — 3i08Aty Sree ‘aorcan Exess Cenarion Bank Account Type Checking Bank Address American Express Centurion Bank 4318 South 2700 West, Salt Lake City, UT 84184 The banking information contained on this check is valid for payroll and eligible government benefits direct, deposit only and should not be used for any other types of financial transactions. Bluebird is issued by ‘American Express Travel Related Services Company, Inc., nota bank. For information on FDIC pass- through insurance and Bluebird, visit www bluebird.comifags. Amount Add my entire paycheck: 100% Signature Xx | authorize my Employer/Payor to initiate credit entries and, ifnecessary, request adjustments to correct any erroneous entries for direct deposit of above payrollother amount to the above account at ‘American Express Centurion Bank on a recurring basis until | notify you in writing that | revoke this authorization. How Long It Will Take You To Get Annual Maximum Direct Deposit Your Money Amount It may take one to two pay periods before You may add up to $100,000 via Direct your Direct Deposit wil take effect. Deposit to your Bluebird Account each year.