Landrum Staffing Services

Thank you for selecting our Automatic Draft payment option. Please complete the information form below. For questions, call the Landrum Payroll/Billing Department at 850-476-5100.

I (we) request and authorize Landrum Staffing Services to initiate debit or credit entries to my (our) account described below, to pay invoices or receive credits for services provided by Landrum, and I (we) authorize the named depository (Depository) to debit the same to my (our) account on the day Landrum processes my (our) payroll. It is understood and agreed that it will not be a set amount, but will vary on each occasion with the amount of payroll reported to Landrum by me (us).

This authority is to remain in full force and effect and cannot be revoked by me (us) until I (we) have advised Landrum and Depository in writing and Landrum has advised Depository in writing that all amounts owed by me(us) have been paid in full. Returned drafts shall be considered the same as a returned check and shall be subject to a 5% NSF charge and other appropriate remedies.

Company Name on account:
Date:
Tax ID Number:
Signer(s) on account:
Approved By:

Depository Name __________________________________________________

Street Address ____________________________________________________

City/State/Zip _____________________________________________________

Transit/ABA No. ________________________ Account No. _________________

YOU MUST ATTACH A COPY OF ONE OF YOUR CHECKS, OR A VOIDED CHECK to this form in order for this request to be processed.

bankdraftplan rev.01/20/06.