AUTOMATED PAYROLL SOLUTIONS, LLC
P.O. BOX 702
SIKESTON, MO.  63801
573-471-1983
                                            Direct Deposit / Authorized Accounts

       Employer:  ____________________________________________________

       Employee Name:  _______________________________________________

       Social Security Number:  ________  -  ______  -  ________

       E-mail Address: __________________________________



Financial Institution #1    Checking             Savings         

Full deposit         Percent  ______%  Specific amount each check date $_________    

Bank Name                 __________________________________________
Bank Address             __________________________________________   
Bank City, State, Zip   __________________________________________      

Routing & Transit No.  __________________________

Account No.                 __________________________  


Financial Institution #2    Checking              Savings        

Full deposit         Percent  ______%  Specific amount each check date $_________

Bank Name                 __________________________________________
Bank Address              __________________________________________   
Bank City, State, Zip    __________________________________________      

Routing & Transit No.   ___________________________

Account No.                  ___________________________  

Please attach a copy of a voided check for each checking account.

I/We authorize Automated Payroll Solutions, LLC, and the Financial Institution(s) listed above to initiate deposits of funds to which I am
entitled automatically to the above listed account(s).  If funds to which I am not entitled are deposited to my account(s), I authorize you to
initiate debit entries and adjustments to return said funds.  This authority shall remain in effect until I have cancelled it in writing at such
time and in such manner as to afford you a reasonable opportunity to act.


Signature _____________________________________  Date ________________