Service Representative Customer

Vanessa Lewis

***** **** ** *** **, Valley Springs, CA 95252

Pay to the order of

Dollars

Date

Memo

084106768 9780001002050598

Account Information

Full Name

Vanessa Lewis

Bank Name

Evolve Bank & Trust

Account Number

9780001002050598

Routing Number

084106768

Direct Deposit Enrollment Form

I authorize my employer or payer to electronically deposit my payroll or benefits check to my Step banking account unless otherwise revoked. This form and the bank routing number and debit account number are for the purpose of initiating direct deposits to the associated Step banking account. 120 Hawthorne Ave, Palo Alto, CA 94301

*****@****.***

Amount

Deposit my entire paycheck.

Deposit % of my paycheck.

Deposit of my paycheck.

Voided Check

Authorization

Signature Date

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