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DIRECT DEPOSIT FORM 7

Direct deposit form

Please review the following information:

NAME ON THE ACCOUNT

DATE

STREET ADDRESS

CITY, STATE, ZIP

BANK NAME

Choose your deposit amount

(pay per cycle)

Entire paycheck

I wish to have my check directly deposited into my Netspend All-Access Account. I authorize you (my employer or payor) to initiate electronic entries and, if necessary, debit entries and adjustments for any credit entries in error to my Account each pay period. This authority will remain in effect until I notify my employer or other payor in writing or as otherwise specified by my employer or payor.

SIGNATURE

R/T (ROUTING) NUMBER 073972181

ACCOUNT NUMBER 700***********

Please note: We do not accept deposits via wire transfers. We do not accept printed checks. Any printed checks sent to us, or to the issuing bank will be returned or destroyed. Direct Deposit must be made in the Accountholder's name only. THE ONLY FEDERAL PAYMENTS THAT MAY BE DIRECT DEPOSITED TO YOUR ACCOUNT ARE FEDERAL PAYMENTS FOR THE BENEFIT OF THE ACCOUNTHOLDER. If you have questions about this requirement, please call Customer Service at the number on the back of your debit card. Direct deposit capability is subject to payor's support of the feature. Check with your payor to find out when the direct deposit of funds will start. Funds availability is subject to the timing of payor's funding.

% of paycheck

Set amount

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IMPORTANT INFORMATION FOR OPENING A NEW DEPOSIT ACCOUNT: To help the federal government fight the funding of terrorism and money laundering activities, the USA PATRIOT Act requires us to obtain, verify, and record information that identifies each person who opens an Account. WHAT THIS MEANS FOR YOU: When you open an Account, we will ask for your name, address, date of birth, and your government ID number. We may also ask to see a copy of your driver's license or other documents at any time. All Accounts are opened subject to our ability to verify your identity by requiring acceptable types of identification. We may validate the information you provide us to ensure we have a reasonable belief of your identity. If we are not able to verify your identity to our satisfaction, we will not open your Account or we may close the Account if it was previously funded. Your Account is subject to fraud prevention restrictions at any time, with or without notice. The Netspend® All-Access® Account is a deposit account established by Pathward®, National Association, Member FDIC. Ouro Global Inc. is a service provider to Pathward, N.A. Certain products and services may be licensed under U.S. Patent Nos. 6,000,608 and 6,189,787.

© 2024 Ouro Global, Inc. All rights reserved worldwide. Netspend is the federally registered U.S. service mark of Ouro Global, Inc. All other trademarks and service marks belong to their owners.

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