I certify that the information provided on this form is true and accurate and that I am authorized to use the bank account listed above. I authorize Advantage Plus Insurance Agency to initiate electronic deposits to this account for commissions, reimbursements, bonuses, and other payments payable to me or my agency. I understand that I am responsible for notifying Advantage Plus Insurance Agency of any changes to my banking information and that incorrect or outdated information may result in delayed or returned payments.

I confirm that I am an owner or authorized signer on the bank account provided above and that the account is authorized to receive payments on my behalf.

I certify and agree that all information I have entered and submitted on this form is complete, accurate, and correct, and that I have carefully reviewed the banking information provided before submitting this authorization.

I understand that Advantage Plus Insurance Agency will rely on the information I provide to process direct deposit payments. I accept responsibility for ensuring that the account holder name, routing number, account number, account type, and all other banking information submitted are correct.

If a payment is deposited, transferred, rejected, delayed, returned, or otherwise misdirected as a result of incorrect, incomplete, outdated, or inaccurate banking information that I provided on this form, I acknowledge that Advantage Plus Insurance Agency will not be responsible for any resulting delay, loss, fee, or other consequence to the extent permitted by applicable law.

I further understand that I am responsible for promptly notifying Advantage Plus Insurance Agency of any change to my banking information and submitting a new Direct Deposit Authorization before future payments are processed.

By checking this box and submitting this form, I confirm that I have reviewed and agree to this authorization and acknowledgment.