CONSUMER AUTHORIZATION FOR DIRECT DEPOSIT VIA ACH (ACH CREDITS) Direct Deposit via ACH is the deposit of funds to a consumer’s account. The deposit will be for reimbursement of allowable law school student loan payments. I hereby authorize North Carolina Legal Educations Assistance Foundation (“NC LEAF”) to electronically credit my account (and, if necessary, to electronically debit my account to correct erroneous credits) at the depository financial institution named below.NC LEAF Recipient Name(Required) First Middle Last NC LEAF ID Number(Required) Your NC LEAF ID Number is your NC Bar License Number with your 4 number PIN at the end (e.g. 12345-1234). If you need your PIN resent, please email us.Please select your Organization(Required)NC LEAF RecipientLegal Aid of NC EMPLOYEEEmail Address(Required) Enter Email Confirm Email Depository (Bank) Name(Required) Name(s) on Account(Required) Select One(Required) Checking Account Savings Account Where to find your Routing & Account Numbers:Routing Number(Required) Account Number(Required) Account Number (confirm)(Required) HiddenAccount Number ValidationAccount numbers do not match. Please re-enter the account number to proceed.Acknowledgement(Required) I understand that this authorization will remain in full force and effect until I notify NC LEAF in writing that I wish to revoke this authorization. I understand that NC LEAF requires at least 30 days prior notice to cancel this authorization. The NACHA Operating Rules do not require the consumer’s express authorization to initiate Reversing Entries to correct erroneous transactions. However, Originators should consider obtaining express authorization of debits or credits to correct errors.Signature(Required)HiddenSubmission Date MM slash DD slash YYYY
