TDI-Brooks International

Business Office 14391 South Dowling Road, College Station, TX 77845 Phone (979) 693-3446 Fax (979) 485-9850 gailmills@tdi-bi.com

Authorization for Direct Deposit Form

This authorizes TDI-Brooks International, Inc. (the "Company") to send credit entries (and
appropriate debit and adjustment entries), electronically or by any other commercially accepted method,
to my account indicated below (the "Account"). This authorizes the financial institution holding the
Account to post all such entries.

Type or Print Plainly in Block Letters:

Account Holder’s Name (exactly as listed on the bank account):

Account Holder’s Address:

Beneficiary Bank Account or IBAN #:

Account Type (Checking or Savings):

Name of Beneficiary Bank:

Location of Beneficiary Bank:

ABA Routing # for US Banks:

If Not a US Bank:

Beneficiary Bank SWIFT or BIC:

Intermediary Bank ABA Routing # for US Banks:

Intermediary Bank Name:

Intermediary Bank Location:

Other Necessary Bank Information as required by your beneficiary bank:

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I authorize the transfer of:
□ All funds payable to me to this account.

□ Partial amount of funds payable to me in the amount of: USD $

With the balance of funds payable to me:

🌕Held until a future date of:

🌕Transferred to the account of :
[Bank information to be attached.]

One wire transfer per month will be paid for by the company. Any additional wire transfers will
incur bank fees of $45 per wire. If requesting additional wire transfers of funds payable to me, I
authorize the deduction of the $45 bank fee from my funds payable.

This authorization will be in effect until the Company receives a written termination notice from myself and
has a reasonable opportunity to act on it.

Signature:

Printed Name:

Social Security or Passport #

Date:

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