Authorization Agreement Form COMPANY NAME: World Financial Group

For Direct Deposit (ACH Credits)

❒ NEW ❒ Change (select one)

ONE Associate and ONE Code # Per Form ONLY

Mail OR Fax this Agreement PLUS a Voided Check or Deposit Slip to:
World Financial Group, ATTN: Commissions Department – Direct Deposit Signup,
11315 Johns Creek Parkway, Duluth, GA 30097, FAX: 678-966-6263

YOU MUST INCLUDE A VOIDED CHECK

(Deposit Slips are allowed for Savings Accounts ONLY)

Personal Information
Name (PRINT Full Name) (ONE Associate per form) Associate Code # (ONE Code # per form)

Address (Street, City, State, Zip) Phone

(H) (W)
DEPOSITORY (Financial
Institution/Bank)
Bank Name Address (Street, City, State, Zip) Phone (Required)

Account Information

Type of Bank Account ALL Account Owners

Bank accounts with Taxpayer Identification (i.e. authorized signers)
Numbers (TIN) are NOT allowed. Please refer
to the FULL list of Allowed and Not-Allowed
bank accounts online)

Note: The location of the check and account

number may be different on your check.
Name on Account: Type of Bank Account

___________________________ ❒ Savings ❒ Checking (select

one)
Account # __________________
❒ Individual ❒ Joint (select one)
Routing # ___________________
I hereby authorize World Financial Group (WFG), hereinafter called COMPANY, to initiate credit entries to my account
indicated above at the financial institution named above, hereinafter-called DEPOSITORY. This authorization is to
remain in full force and effect until COMPANY has received WRITTEN notification from me of its termination in such
time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it

___________________________________________ ___________________________________________
Associate Signature Date

NOTE: If you close the account selected for direct deposit and do NOT submit a new Authorization Agreement marked "CHANGE"; your
commission payment will be delayed since the bank will reject your direct deposit transaction and you will be issued a check for the transaction not
processed by the bank.