Milestone, Inc.

DIRECT DEPOSIT AUTHORIZATION

( ) Initial Authorization ( ) Change in Bank ( ) Change in Account

***INITIAL AUTHORIZATION OR CHANGE IN DIRECT DEPOSIT WILL TAKE TWO PAY CYCLES.

THE FIRST PAY CYCLE YOU WILL RECEIVE A CHECK WHILE YOUR ACCOUNT IS BEING "PRENOTED."

THE SECOND PAY CYCLE WILL BE DIRECT DEPOSITED

Attach Voided Check for Checking Account
OR
Attach Savings Deposit Slip for Savings Account

ATTACH VOIDED CHECK OR SAVINGS DEPOSIT SLIP IN BOX ABOVE

Please choose one of the following:

Yes / Yes, continue to print my check stub.
No / No, please do not print my check stub. I will request a copy if I need it.

Type of account (check only one):

CHECKING / Attach Voided Check
SAVINGS / Attach Savings Deposit Slip

I authorize Milestone, Inc. to directly deposit my net pay into the account designated above.

I acknowledge that I have read and agree to abide by the Direct Deposit Guidelines on the reverse side of this form.

I understand that it is my responsibility to notify Milestone, Inc. immediately should I change financial institutions. I also authorize Milestone, Inc. to correct any Electronic Funds Transfer resulting from an erroneous overpayment by debiting my account to the extent of such overpayment.

Employee Name (print) Employee Signature Date

Office use only

Employee #

Prenote Test Date: Accounting Dept Initials:

Pay date Direct Deposit is Effective: Accounting Dept Initials:

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MILESTONE, INC.

DIRECT DEPOSIT GUIDELINES

Initial Authorization or change in Direct Deposit will take two pay cycles. The first pay cycle you will receive a payroll check while your account is being pre-noted. Milestone submits a pre-note or test file to the bank at the time of authorization to verify the ABA routing number and Account Number of the financial institution you provided to us. Assuming the data is valid and entered into our payroll system correctly, the direct deposit of funds will be made in the second pay cycle. You will continue to receive a payroll stub showing your hours paid, taxes withheld, other deductions, gross pay and amount deposited into your account after direct deposit is effective.

Net Pay: Direct Deposit must be 100% of an employee’s net pay.

Account: An employee’s net pay may be deposited into only ONE account.

Depository: An employee’s account must be with a financial institution that is a member of the Automated Clearing House network. Most banks, savings and loans, and credit unions meet this requirement.

Discontinuation of Direct Deposit may be accomplished at any time. However, it is the employee’s responsibility to inform the accounting department in writing at least one week in advance of the pay date for which discontinuance of direct deposit is desired.

Changes in Account Status: Any change in financial institution or account number will require the same two pay cycle process as an initial authorization. It is the employee’s responsibility to inform the accounting department in writing of any desired changes at least one week in advance. If you close a bank account, you must notify us immediately. Funds deposited into a closed or invalid account will not be replaced until they have been returned to Milestone.

U.S. Mail: Should an employee desire their check stub or payroll check to be mailed to them, they must provide a self-addressed stamped envelope for this purpose. Any payroll check or check stub not picked up from a designated payroll location will be returned to the accounting department on the Monday after pay day and be available for pick-up unless a self-addressed stamped envelope is provided.

Payroll Adjustments: In the event a payroll error results in monies being due to an employee, Direct Deposit will not be available unless the employee chooses to wait until the subsequent pay cycle for payment. Underpayments due to Milestone error will be corrected by the issuance of payroll checks.

Questions, Problems, or Forms Availability: Employees may contact the accounting department with any questions or problems. All designated payroll locations will have forms available.