GBC Services

1360 Union Hill Rd, Alpharetta, GA 30004Phone (678) 366-9232 Fax (678) 366-9250

New Account Account Change

Employee Name _______________ SSN _______________ Employer Name ____________ I hereby authorize GBC Services, LLC to make payments owed to me byinitiating credit entries or adjustment entries to the account number indicated in the blank below and I herebyauthorize such bank to accept any debit/credit entries initiated by GBC Servces to such account. Ifmoney to which I am not entitled is deposited into my account, I authorize GBC Services to direct myfinancialinstitution to return said funds. I am responsible for verifying all the deposits with my bank beforeissuingany checks against my account. The authority is to remain in full force and effect until the PayrollDepartment has received WRITTEN notification of its cancellation from me.

• Please be advised that it may take a maximum of 2 pay periods before your paycheck is deposited into yourbank account. During this time you will receive a live paycheck in your department.

• Please be advised that when you make a change to your bank account, you will receive a live paycheck fortwo pay cycles. If your check continues to be deposited into your old account, please contact the PayrollDepartment.

• Please be advised that when you cancel your direct deposit, it will be effective in the next pay cycle. Theremay be a one-day delay dependent upon when your request is received by the Payroll Department. If yourpaycheck continues to be deposited into your account, please contact the Payroll department.

(1) Primary Account Type of Account □ Checking □ SavingsFinancial Institution Telephone #

Branch Routing #

Mailing Address Account #

City State Zip Code Amount per pay Period $ .

(2) Secondary Account Type of Account □ Checking □ SavingsFinancial Institution Telephone #

Branch Routing #

Mailing Address Account #

City State Zip Code Amount per pay Period $ .

__________________________________________ ____________________Employee Signature Date

Please return this form to your employer's HR Department. Your employer's HR department willforward this form to GBC Services

Direct DepositAuthorization Agreement

PAYROLL SERVICES

Attach a Voided Check in this SpacePlease call your financial institution to confirm your routing number