American Telesis

DIRECT
DEPOSIT

DIRECT DEPOSIT AUTHORIZATION

For the convenience of our Agents, American Telesis offers Direct Deposit of your bonus and monthly commissions. We will pay you via ACH whereby we wire the money directly into your designated bank account and email/fax you your monthly statement. The deposit will appear in your bank account the next morning! If you do not wish to get your monthly check via Direct Deposit, we will mail you your statement and check.

Name on Bank Account		_______________________________________

Bank Name		_______________________________________

ABA Routing Number		_______________________________________

Bank Account Number		_______________________________________

Fax or Email to send Statements		_______________________________________

Authorized By		_______________________________________
		Signature	Title

	PLEASE PRINT AND FOR SECURITY PURPOSES FAX COMPLETED FORM TO MICHELE GREEN AT 843.842.9731 You will receive a confirmation via email.

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