Authorization for Direct Deposit (Step 5 of 6)

I authorize Kostic Healthcare to deposit my pay automatically to the account(s) indicated below and, if necessary, to adjust or reverse a deposit for any payroll entry made to my account in error. This authorization will remain in effect until I cancel it in writing and in such time as to afford Kostic Healthcare a reasonable opportunity to act on it.


Account type

*Balance of pay to:

*Note: Split payments are not available for contractors


Account type

Important: Please attach a voided check for each bank account to which funds should be deposited. You can upload your scanned voided check from the "Browse files" link .

Browse files
Size limit for each file is 100 MB