Direct Deposit Authorization

To: _____________________________________________________________________

(Company Name/Employer)

I authorize you to electronically deposit my net pay each payday to my First Star Bank account listed below:

Select one of the following: ___ Checking _____ Statement Savings _____ Money Market

Account number: ___________________________________________________________

First Star Bank Routing/ABA Number: 231371786

Please use the following personal information and signature as authorization, or to contact me with any questions:

Name: ___________________________________________________________________

Street Address: ____________________________________________________________

City: ___________________________ State: __________ Zip Code: _________________

Daytime Phone: _____________________ Social Security Number: ___________________

Employee Number (if applicable): _______________________________________________

_____________________________________ _________________________

Signature (required) Date