Authorization Voluntary Wage Direct Deposit

This Authorization for Voluntary Wage Direct Deposit (“Direct Deposit Authorization”) authorizes my employer (the “Company”) to make deductions to my payroll check and to send the deducted amounts to my Brightside Payroll Services Account (“My Account”) on the terms described below. 

I am currently receiving certain services from Brightside under a program participated in by the Company for the benefit of the Company’s employees (the “Brightside Program”).  Under the Brightside Program, I will provide instructions to Brightside as to the amounts of my payroll check that I want to be directly deposited to My Account and the dates of such direct deposits. 

By clicking “I AGREE” below, I authorize the Company and its payroll service providers to take directions from Brightside as to the amounts to be deducted from my payroll check and deposited to My Account (the “Payroll Deductions”) and to make such Payroll Deductions on the dates instructed by Brightside.  I also authorize the Company to provide a copy of this Direct Deposit Authorization to Brightside. 

My Account:  My Custody Account at Evolve Bank & Trust associated with Brightside

I also represent, acknowledge, and agree as follows:

  • I understand that I can revoke this Direct Deposit Authorization at any time by notifying Brightside at support@gobrightside.com.  I acknowledge that Brightside must receive my revocation  in time to process it before my next scheduled Payroll Deduction, which I agree must be at least 3 business days before the scheduled date for the next Payroll Deduction.

  • I represent that this Direct Deposit Authorization is made voluntarily by me and is not made as a condition of my employment.

  • I further represent that this Direct Deposit Authorization is made for my personal benefit and convenience.

  • I acknowledge that the Company, its affiliated entities and its third-party benefits administrators are not deriving any benefit, such as commissions or fees, from this Direct Deposit Authorization.

  • I represent that the deductions made under this Direct Deposit Authorization are not being made for political reasons, nor to pay for supplies, tools, uniforms, or any other debt that may be owed to the Company.

  • I agree and acknowledge that, in the event my employment with the Company shall terminate, either voluntarily or involuntarily, the above Payroll Deductions shall automatically stop as of my last day of employment. 

 

 

Authorization for Automatic Payments

This Authorization for Automatic Payments (“Authorization”) authorizes (the “Provider”) to debit my Brightside Payroll Services Account (“My Account”) on the terms and in the amounts and dates described below (the “Automatic Payments”).   

I am currently receiving certain services from Brightside under a program established by Brightside for employers and their employees (the “Brightside Program”).  Under the Brightside Program, I will provide instructions to Brightside as to the amounts and dates of my Automatic Payments to the Provider. 

By clicking “I AGREE” below, I authorize the Company to take directions from Brightside as to the amount and date of each Automatic Payment from My Account, and I authorize the Company to make Automatic Payments from My Account based on and in reliance on such instructions from Brightside.  I also authorize the Provider to provide a copy of this Authorization to Brightside. 

My Account:  My Custody Account at Evolve Bank & Trust associated with Brightside

Payment Dates and Automatic Payment Amounts:  As communicated to the Company by Brightside on my behalf and as described above.

Stopping Payments; Cancellation of Authorization: I understand that this Authorization will remain in full force and effect until I notify Brightside orally or in writing at support@gobrightside.com or by calling 855 216-2750 that I am not breaking terms of my agreement with Provider and wish to cancel this Authorization.   

Changes to Automatic Payment Amounts: I acknowledge that, if any scheduled Payment Amount will be different than the prior Payment Amount, Provider will notify me at least 10 days before the scheduled Payment Date.