DIRECT DEPOSIT ENROLLMENT FORM

DIRECT DEPOSIT SIGN-UP INSTRUCTIONS

1) Print this form. 2) Complete the form in its entirety including signing and dating. 3) Turn the form in to your employer. Please note that your employer may ask you to complete a separate direct deposit form. If so, the sample voided check and account information provided on this form will allow you to complete that form. 4) It is recommended that you make a copy for your records.

Your Prepaid 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 preauthorized direct debits will be declined and your payment to the merchant or provider will notbe processed. The bank routing number and direct deposit account number are for the purpose of initiating direct deposits to your Prepaid Card accountonly.You are not authorized to provide this bank routing number and direct deposit account number to anyone other than your employer or payer.

GLADYS MARTINEZ
14238 WHITEROCK DR LA MIRADA, CA, 90638

Bank Routing Number:

063115194

Account Number:
9870000000650

CHOOSE AMOUNT TO DEPOSIT:

100% of pay Other % of pay: ___________% Set amount:$ ___________

DIRECT DEPOSIT AUTHORIZATION

I hereby authorize (insert Employer name) ______________________ to initiate credit entries to the DIRECT DEPOSIT ACCOUNT # referenced above per pay period. This authorization shall be effective as of the date signed and will remain in effect until revoked by me in writing.

______________________________
Signature

____________________
Date

Please call Customer Service at (855) 841-1203 WITH ANY QUESTIONS. Direct Deposit Terms and Conditions: I understand that I have the option of receiving all or part of my wages,expense reimbursements, bonuses, and other employment-related or government benefit payments ("Payments") from the Payor by electronic funds transfer to my Next CALAPrepaid Card ("Card") issued by The Bancorp Bank ("Bank"). I authorize the Payor to make Payments to my Card by initiating electronic entries (and, if necessary, debit entries andadjustments for any credit entries in error) to my Card account. I understand that if I have arranged to have direct deposits made to my account at least once every 60 days from thesame Payor, I can call (855) 841-1203 or visit www.nextcala.com to find out whether or not the deposit has been made. I understand that: (i) I may cancel this authorization at any timeby sending a written notice to the Payor at least 5 business days in advance of any payment; (ii) Payor may terminate this method of payment, with or without cause, at any time; (iii)Payments made to my Card will be subject to the terms of my Next CALA Prepaid Card Cardholder Agreement with the Bank; (iv) I may continue to receive Payments by check or (ifapplicable) direct deposit to a bank account until this authorization is processed and my Payments are added to my Card; and (v) funds from electronic direct deposits will generally beavailable on the day the Bank receives the deposit. (In case of transmission error or deposit irregularity, your ability to withdraw funds may be delayed beyond the first business day,but the funds will generally be available within 5 business days after the deposit. Your Prepaid 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 p resented for payment, these p reauthorized direct debits will be declined and your payment to the merchant or provider will not be processed. The bank routing number and directdeposit account number are for the purpose of initiating direct deposits to your Prepaid Card Account only. You are not authorized to provide this bank routing number and directdeposit account number to anyone other than your employer or payer. Direct deposit capability is subject to payer's support of this feature. Check with your payer to find out when the direct deposit of funds will start. Funds availability is subject to timingof payer's funding.