Direct Deposit Enrollment

Instructions

This form must be completed by independent contractors requesting automatic deposit of commission checks and will be retained on file by the Agency.

Deposit Account Information

Name

First Last

Email

Phone

Account Type*

Checking Account
Savings Account

Bank Routing Number (ABA Number)*

Bank Account Number*

Upload Voided Check

Accepted file types: jpg, jpeg, png, gif.

uploading a voided check is optional but recommended for each bank account to help verify account numbers and bank routing numbers. Failure to provide a voided check will result in $15 fee for all failed payments to the listed account

Signature*

This authorizes KRZI, LLC dba Chubit Travel (the “Company”) to send credit entries (and appropriate debit and adjustment entries), electronically or by any other commercially accepted method, to my (our) account(s) indicated below and to other accounts I (we) identify in the future (the “Account”). This authorizes the financial institution holding the Account to post all such entries. I agree that the ACH transactions authorized herein shall comply with all applicable U.S. Law. This authorization will be in effect until the Company receives a written termination notice from myself and has a reasonable opportunity to act on it.

Printed Name*

First Last

Date*