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CXN Direct Deposit Authorization

Direct Deposit Authorization

P.O. Box 403 ♦ Knoxville, Tn 37901 ♦ 855-773-1193

Name:

Social Security or Federal Employer ID Number:

I hereby authorize CXN Corp (“CXN”) to direct deposit to my account at the financial institution (“Bank”) identified below, by means of initiating credit entries or otherwise, any amounts owed me by CXN. I further authorize BANK to credit to my account any funds submitted by CXN by credit entries or otherwise. Any dispute arising out of or in connection with this agreement, if not otherwise resolved, shall be determined by the laws of the State of Tennessee and shall be decided by binding arbitration in Tennessee in accordance with the rules of the American Arbitration Association. Both parties agree that the prevailing party in any arbitration shall be awarded costs and attorney fees, and that the award for costs and attorney fees may be entered as a judgment in any jurisdiction in which the non-prevailing party does business. This authorization is to remain in full force and effect until CXN and BANK have received written notice from me of its termination in such time in such manner as afford CXN and BANK a reasonable opportunity to act on it.

Please write legible to ensure account information can be transcribed correctly.

✷Your direct deposit will be sent out in a timely manner to be credited to your account on your

check date. However, CXN cannot make any warranty that such funds will in fact be available. You

should check with your individual bank for any such warranty.

✷If you provide incorrect information and your deposit is returned CXN will pass on any and all fees for returned electronic deposits.

Bank Name: Bank Phone:

Routing (#): Account (#):

INDEPENDENT CONTRACTOR

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Your legal name

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Timestamp

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2016-01-05 01:45:17 EDT

CXN Direct Deposit Authorization Uploaded by Trent Harvey - [email protected] IP 73.121.100.111