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Direct Deposit Authorization Form

Please print and complete ALL the information below.

Name

Full Address

Name of Bank

9-Digit Routing #:

Account #:

Type of Account *

Checking

Savings

Please upload a voided check for each bank account to which funds should be deposited.

Upload File

Upload supported file (Max 15MB)

Employee Assistance Associates and Consultants of Oklahoma is hereby authorized to directly deposit my pay to the account listed above. This authorization will remain in effect until I modify or cancel it in writing.

Your Signature

Thank you for submitting. We have received your changes.

Employee Assistance Associates and Consultants of Oklahoma

6585 S. Yale Ave Suite 340

Tulsa Oklahoma 74136

918-481-2999 or 1-800-477-2990

Fax: 918-393-4055

Copyright© 2045 EAACO. All rights reserved.

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