One account per employee — complete this form and attach a voided check (not a deposit slip).
I authorize Bella Mente, Inc. (the “Employer”), directly or through its payroll service provider, to deposit my net wages by initiating credit entries to my account at the financial institution listed below, and I authorize that financial institution to accept and credit those entries to my account. Our payroll system supports ONE deposit account per employee; this authorization replaces any account previously on file.
If funds are ever deposited into my account in error, I authorize the Employer or its payroll provider to reverse the erroneous credit entry, not to exceed the amount of the error, in accordance with applicable NACHA operating rules. Any other recovery of amounts from my wages will occur only as permitted by Minnesota law (Minn. Stat. §181.79), which requires my separate, voluntary written authorization after the claimed debt arises.
I understand that I may decline or revoke this direct deposit authorization at any time by written notice, without retaliation, and that I have the right to be paid by other lawful means. This authorization remains in effect until the Employer receives my written termination notice and has a reasonable opportunity to act on it.
Attach or bring a voided check (not a deposit slip) for this account so the office can verify the routing and account numbers.
