MONTANA PAYROLL CARD AUTHORIZATION I consent to have my wages deposited onto a [NAME OF ISSUER] payroll card as the method of receiving my wage payments. I understand that my consent to receive wage payments on a payroll card is purely voluntary and is not a condition of hire or continued employment. If I do not choose to receive wage payments through payroll card, I may choose to be paid by the following methods: Cash [IF APPLICABLE, MUST OFFER AT LEAST CASH OR CHECK] Check Direct deposit (with my written authorization) I may make an initial withdrawal of up to and including the net amount my wages, without cost. I am entitled to change my method of receiving wage payments at any time, and any requested change will be made as soon as feasible. [NAME OF EMPLOYER] has provided me with a full and complete description of the terms and conditions of the use of my [NAME OF ISSUER] payroll card, including a schedule of all applicable fees. I have read and received a copy of this form. ____________________________________________________ _______________ Signature Date
MONTANA PAYROLL CARD AUTHORIZATION I consent to have my wages deposited onto a [NAME OF ISSUER] payroll card as the method of receiving my wage payments. I understand that my consent to receive wage payments on a payroll card is purely voluntary and is not a condition of hire or continued employment. If I do not choose to receive wage payments through payroll card, I may choose to be paid by the following methods: Cash [IF APPLICABLE, MUST OFFER AT LEAST CASH OR CHECK] Check Direct deposit (with my written authorization) I may make an initial withdrawal of up to and including the net amount my wages, without cost. I am entitled to change my method of receiving wage payments at any time, and any requested change will be made as soon as feasible. [NAME OF EMPLOYER] has provided me with a full and complete description of the terms and conditions of the use of my [NAME OF ISSUER] payroll card, including a schedule of all applicable fees. I have read and received a copy of this form. ____________________________________________________ _______________ Signature Date
MONTANA+PAYROLL+CARD+AUTHORIZATION.docx