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Direct Deposit Enrollment Form

Bank Information

Bank Name: PNC Bank

Address: 500 1st Ave, Pittsburgh, PA
15219-0000

Account Information
Provide to your payer/employer in lieu of a voided check.

Name: Richard Elliott

Routing Number: 031203999
Account Number: 897004720614

Authorization

I authorize ________________________ (employer/payer) to initiate credit entries, and, if necessary

to initiate any debit entries to correct previous credit errors, to my indi account. This authority will
remain in effect until I notify my employer or other payer in writing or as otherwise specified by my
employer or payer.

Signature Date

Banking Services provided by PNC Bank, Member FDIC. The indi Visa ® Prepaid Debit Card is issued by PNC Bank pursuant to a license from Visa
U.S.A. Inc. and may be used everywhere Visa debit cards are accepted.
Direct deposit capability is subject to your payer’s support of this feature. Check with your payer to find out when the direct deposit of funds will
start. Fund availability is subject to the timing of the payer’s funding.
The recipient’s name on any deposits received must match the name of the indi member. Any deposits received in a name other than the name
registered to the indi account will be returned to the originator.