ACBXpress Corp
Direct Deposit Authorization
I authorize ACBXpress Corp to deposit payments owed to me into the account identified below and, when permitted by law, correct an erroneous credit.
This authorization remains effective until I provide written notice allowing reasonable time to act. I certify that I am an authorized owner or signer on this account and that the information supplied is accurate.
Account holder
Name on accountName on account
OwnershipOwnership
Account typeAccount type
Financial institution
Bank nameBank name
Bank phoneBank phone
Bank addressBank address
Deposit account
Routing numberRouting number
Account numberAccount number
DateDate
SignatureSignature