Direct Deposit Enrollment Request Form

I authorize my employer (issuer) to initiate credit entries to my bank account listed below.

First Name
nashwan

Last Name
adel aljabali

Complete Address

6054 cronin drive

Phone Number
3136887000

Account Name / Company Name:

nashwan A aljabali

Account Holder's Name

nashwan a aljabali

Account Number:
375021679417

Routing Number
072000805

​I understand that if monies to which I am not entitled are deposited into my account, I authorize my employer (issuer) to direct the
financial institution to return said funds and I authorize the financial institution to act on the employer (issuer) and to return said funds.
This authority will remain in effect until the employer (issuer) has received written notification from me of its termination in such time and
in such manner as to afford the employer (issuer) and financial institution a reasonable opportunity to act on it.
​

Name: nashwan adel adel aljabali

Applicant Signature: Signature Date: 09/25/2023