Behavior Education Services, provider of ABA services
Enter first 9 digits found at bottom left of a personal check:
Choose your account type:
Put your Checking/Savings Account Number:
Choose one you wish to deposit:
---% of NetSpecific Dollar AmountFull Net Pay Amount
• % of net pay = A percentage of your net pay amount will be deposited into your account.(Ex. 5% of a $100.00 check=$5.00 being deposited in your account).
• Specific Dollar amount = A specific dollar amount you choose will be deposited into your account.
• Note: if either of these options is chosen, the remainder of your net pay amount will be given to you and as a paper check.
If you choose "Full Net Pay Amount" you don't need to enter an amount
EMPLOYEE/WORKER CONFIRMATION STATEMENT
I authorize my employer/company to deposit my earnings into the bank account(s) specified above and, if necessary, to electronically debit my account to correct erroneous entries. I certify my account(s) allow these transactions. Furthermore, I certify that the above listed account number accurately reflects my intended receiving account. I agree that direct deposit transactions I authorize comply with all applicable laws. My signature below indicates that I am agreeing that I am either the accountholder or have the authority of the accountholder to authorize my employer/company to make direct deposits into the named account.
Main Office Northridge
8940 Reseda Blvd #102, Northridge
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