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Instructions: 1. Complete this authorization form. 2. Please enter the last 11 digits of your card number to complete your account. 3. Submit the completed form to your employer for processing. Processing Information: The following information will be used to process Direct Deposit to the card. Print Employee Name: ABA Routing Number: Account Number: Employee Signature:

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Your prepaid MasterCard card account and associated direct deposit account number cannot be used for preauthorized direct debits from merchants or from utility or Internet service providers. If presented for payment, these pre-authorized direct debits will be declined and your payment to the merchant or provider will not be processed. The bank routing number and direct deposit account number is for the purpose of initiating direct deposits to your prepaid MasterCard card account only. You are not authorized to provide this bank routing number and direct deposit account number to anyone other than your employer.

Authorization: I hereby authorize (Employer Name) to initiate deposit entries of my net pay and to initiate, if necessary, any corrections or adjusting entries to any deposits made in error to my Endeavor Card Prepaid MasterCard card account issued by The Bancorp Bank. I further authorize The Bancorp Bank to deposit and/or apply correcting entries to my Endeavor Card Prepaid MasterCard card account. The following deposit(s) are authorized for each pay period as follows: (Check one box only): Deposit my entire paycheck. Deposit $ of my net pay. Deposit % of my net pay.

The Endeavor Card Prepaid MasterCard is Issued by The Bancorp Bank pursuant to license from MasterCard International Incorporated. The Bancorp Bank; Member FDIC. MasterCard is a registered trademark of MasterCard International Incorporated.


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