Authorization for Direct Deposit


Direct Deposit via ACH is the deposit of funds to a consumer’s account.

I (we) hereby authorize CleanIt LLC (“COMPANY”) to electronically credit my (our) account (and, if necessary, to electronically debit my (our) account to correct erroneous credits) as follows:

Type of Account:

Routing Number: Account Number:
Your Full Name, as seen on Account:

Street Address:
City: State: Zip:

Date of Birth: *

Phone Number:

Last Four of Social Security Number:

Photo of Voided Check:

Upload Voided Check Here

I (we) understand that this authorization will remain in full force and effect until I (we) notify COMPANY in writing via email that I (we) wish to revoke this authorization. I (we) understand that COMPANY requires at least 2 weeks prior notice in order to cancel this authorization.

  1. Independent Contractor:

    Contractors Signature:

9/10/2020 @ 11:21:52 undefined (UTC)

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