JAY VENDING COMPANY DIRECT DEPOSIT AUTHORIZATION
Checking Accounts: Please complete this form and attach a voided check for account verification.
Savings Accounts: Please complete this form and attach a savings deposit or withdrawal slip for account verification.
Employee Name
Last
First
(
)
Phone Number
M.I.
JVC Employee Social Security Number
Employee Email Address
Parent/Guardian Email
(If Under 18 yrs. Of Age)
I authorize Jay Vending Company and the financial institution listed below to initiate electronic credit entries, and if necessary, debit
entries and adjustments for any credit entries in error to my account.
NOTE: If an employee is under 18, a parent/guardian AND the employee must both be listed on an account in order to set up direct
deposit.
JVC Employee Signature
Parent/Guardian Signature
(If Under 18 yrs. Of Age)
Bank Account Information:
New Request
PLEASE PRINT CLEARLY
Change
Cancel Direct Deposit
Bank Name
Bank City and State
Bank Phone Number
Routing Number
Account Number
(Routing Number is 9 digits; located in the lower, left-hand side of a check - See sample below and/or call your bank to confirm.)
Type of Bank Account
Checking
Savings
SAMPLE CHECK:
Please include a voided check or Savings Deposit/Withdrawl slip with this authorization form and send or fax to:
Jay Vending Company
HR Department
2141 Priest Bridge Drive #2
Crofton, MD 21114
Fax # 410-721-9136