Chancellor & Chancellor, Inc.

Employee Direct Deposit Authorization Agreement

I hereby authorize my employer, Chancellor & Chancellor Inc., (hereinafter CHANCELLOR) to deposit any amounts owed me by initiating credit entries to my account at the financial institution (hereinafter BANK) indicated below. Further, I authorize BANK to accept and to credit entries indicated by CHANCELLOR to my account. In the event that CHANCELLOR deposits funds erroneously into my account, I authorize CHANCELLOR to deposit my account for an amount not to exceed the original amount of the erroneous credit.

Employee Information

Employee Name (please print) .......................................................

Social Security Number .................... - .................... - ....................

__ Begin Deposit    __ Change Information    __ Cancel

Bank Name ................................................................

City ................................................... State................

__Checking

     I wish to Deposit (check one)  __ $............ .00    __...........% Net    __ Entire Net Pay

	 
__ Savings

     I wish to Deposit (check one)  __ $............ .00    __...........% Net    __Entire Net Pay 


This authorization is to remain in full force and effect until CHANCELLOR and BANK
have received written notice from me of its termination in such time and in such
manner as to afford CHANCELLOR and BANK a reasonable opportunity to act on it.




Employee Signature....................................................      Date ........ / ........ / ........

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Please fill out the form above and fax it back as soon as possible. Also, please fax a voided check, which contains your bank account number and bank routing information. In California, fax to 415 435-5532; in U.S. fax to 775-831-1353.