Direct Deposit Form

Chaquita Butler

CUSTOMER NAME

Banking services provided by Sutton Bank, Member FDIC.

041215663 1324641926855

AUTHORIZATION

I, , authorize Chaquita Butler Womply

to directly deposit my wages (less lawful withholdings and deductions), or earnings, as

applicable, to my Cash App account, including my final pay upon termination of my

employment or engagement.

This authorization replaces any previous direct deposit authorization and shall remain in effect

until my employer receives written notification from me of its termination. The information

for my Cash App account is provided above.

I wish to deposit Entire paycheck% $

5 / 12 / 21

SIGNATURE DATE

Cash App | 1455 Market St, Suite 600 | San Francisco, CA 94103

Questions? Contact [email protected]