Date
I hereby authorize and instruct EXCELSIOR DEFENSE, INCORPORATED; (the "Company") to deposit the amount of each of my payroll payments directly into my checking and/or savings account indicated below in the amounts indicated below in the Deposit Instruction and to make any such withdrawals directly from my account or accounts as are necessary to correct any incorrect deposit by the Company under this Authorization.
I further hereby authorize and instruct (the "Bank") to accept such automatic deposits to or withdrawals from my account or accounts and to cause my account or accounts to be automatically credited or debited (as the case may be) in the amount of such deposits or withdrawals by the Company without and responsibility for correctness of any such deposit or withdrawal.
I understand that I can cancel this authorization at any time. To cancel I must give written notice to both the Company and the Bank. My cancellation will become effective as to the Company when the Company receives my notice of cancellation and has had a reasonable period of time upon which to act on it. Any automatic deposits to or withdrawals from my account. or accounts by the Company up until that time will be authorized by this authorization. My cancellation of this authorization will become effective as to the credits or debits made to my account or accounts by the Bank when the Bank receives my notice of cancellation and has had a reasonable period of time upon which to act on it. Any automatic credits or debits made to my account or accounts by the Bank up until that time will be authorized by this authorization.
I further understand that all automatic deposits and credits to or withdrawals and debits from my account or accounts tinder this authorization will be subject to all rules, regulations, agreements and disclosure statements of the Company and the Bank governing accounts and preauthorized transfers to and from accounts.
I hereby state that I have received a completed copy of this authorization on the date signed this authorization.
Completing the information below will act as your signature. A Valid eMail address will also be needed so you recieve confirmation.
Employee Name
Social Security Number
Date of Birth
eMail Address needed for Confirmation