Direct Deposit and Withdrawal Information

I, hereby authorize the above-named company to make deposits from time to time in the amount(s) at the Depository Financial Institution(s) (bank), identified below and authorize the bank to accept these deposits. Adjusting entries to correct errors is also authorized. It is agreed that these deposits and adjustments may be made electronically and under the Rules of the Michigan Automated Clearing House Association. This authorization will remain in effect until written notice of termination is given to the company. I acknowledge receipt of a filled-in copy of this authorization.

Name(Required)

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Social Security Number or Federal Tax ID Number(Required)

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First Time Setup

Change of Information

Termination

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Checking

Savings

Each pay period of the month will be deposited into this account.

The following authorization is provided to Elite Driver Systems (EDS) for the withdrawal of funds directly related to the services provided to the carrier whose name and banking information is provided below.

This authorization will terminate upon conclusion of the business relationship between EDS and the carrier named herein.

By signing below, the carrier certifies that the signature is provided by a corporate officer with authority to grant such approval AND periodic withdrawals are authorized for the payment of services provided by EDS to/for the carrier.

*YOU MUST ATTACH A VOIDED CHECK TO THIS FORM. PAY DELAYS MAY OCCUR IF WEDO NOT RECEIVE THIS.*

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