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Direct Deposit Agreement

Authorization Agreement

I hereby authorize Assist Medical Staffing to initiate automatic deposits to my account at the financial institution named below. I also authorize Assist Medical Staffing to make withdrawals from this account in the event that a credit entry is made in error.

Further, I agree not to hold Assist Medical Staffing responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account.

This agreement will remain in effect until Assist Medical Staffing receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to the Payroll Department.

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January 24, 2023 4:46 pm EDT

Direct Deposit Agreement Uploaded by Assist Medical Staffing - staff@assistms.com IP 104.128.161.243

February 6, 2023 1:15 pm EDT

Document owner richard@assistms.com has handed over this document to staff@assistms.com 2023-02-06 13:15:51 - 104.128.161.231