Direct Deposit Authorization Agreement

Employee ID Pay Frequency ________________________ Name ________________________________ Bi-Weekly Weekly

You may choose up to three bank accounts for payroll direct deposits. If you list more than one direct deposit option, the first listed option will be used as your balance account, for the remainder of your net pay after all distributions have been made to other direct deposit options as provided below. If you only select one direct deposit option, that account will be your balance account. To change your direct deposit options should include the new information as well as the information for the account that should be inactivated. All changes are effective on the next available payroll after receipt of agreement: Option 1 (Balance Account): New Account Information to be Activated: Bank Transrouting # (ABA) Account Number Bank Name Amount $ Option 2: New Account Information to be Activated: Bank Transrouting # (ABA) Account Number Bank Name Amount $ Option 3): New Account Information to be Activated: Bank Transrouting # (ABA) Account Number Bank Name Amount $ Percentage % Percentage % Percentage % Checking Savings

Old Account Information to be Deactivated: Bank Transrouting # (ABA) Account Number Bank Name Amount $ Checking Percentage % Savings ________________________

Old Account Information to be Deactivated: Bank Transrouting # (ABA) Account Number Bank Name Amount $ Checking Percentage % Savings ________________________

Old Account Information to be Deactivated: Bank Transrouting # (ABA) Account Number Bank Name Amount $ Percentage % ________________________

Execution on Page 2 must occur as a condition to Direct Deposit Uncompleted form classification: Company Internal Completed form classification: Personal Sensitive Data

Authorizations and Acknowledgements Account Credits. I hereby authorize State Street Bank and Trust Company to send my compensation by direct deposit to the Receiving Depository Financial Institution(s) identified above in accordance with the Companys established payroll frequency and practices then in effect. State Street Bank and Trust Company will initiate credit entries to my account as indicated above, at the Receiving Depository Financial Institution(s) identified above, and will credit the same to such account. Account Debits. I hereby authorize the Company to recover any erroneous deposits consisting of overpayment of wages or compensation to which I have no entitlement (whether such payments are made during or after employment) by debiting the bank account identified above for the amount of the payment in question. I understand that this authorization will continue for one year after my employment ends. Deductions from Pay. I hereby acknowledge and agree that in the event of a payroll error or other overpayment of wages or compensation, amounts overpaid and to which I have no entitlement must be repaid to the Company, and I: a. Authorize the Company to make deductions from pay, and if applicable, final pay in order to make such repayment. Depending upon the amount, the deduction for such a repayment will equal the entire amount of the overpayment, or a series of smaller deductions; and b. Agree that I will repay any remaining balance of such overpayment at the time I cease to be employed by the Company. Additional Important Direct Deposit Information This authorization is to remain in full force and effect until State Street Bank and Trust Company has received written notification from me of its termination, to the Payroll Department JAB1E, in such time and such manner as to afford State Street Bank and Trust Company and the Receiving Depository Financial Institution(s) a reasonable amount of time to act upon it, or, if no earlier notice of termination of this authorization has been provided, for one year after my employment with State Street ends. Any questions on your direct deposit should be directed to Payroll customer service, at 617-985-8004. In the event that you close this account or make any changes to the account you must notify Payroll immediately. The account deemed as your Balance Account will be sent to Accounts Payable to be used for your expense reimbursements. **** Return this form and voided check, if applicable, in a sealed envelope labeled Personal Sensitive Data to Payroll Administrator, Payroll Department, JAB1E **** Signature Date .

Co-Signature (if joint account)

Date

Please note: the employee is responsible for obtaining any necessary signatures for a joint account. Unless noted, State Street will assume all accounts listed to be individual accounts.
Dated: 11/11/09

Uncompleted form classification: Company Internal Completed form classification: Personal Sensitive Data