The Employee Direct Deposit Form
*required fields Note: please use your TAB key to navigate.
Employer Name
*
Employee Name
*
Initial Request
Change in Banking Information
Cancellation
*
BANKING INFORMATION
Note: To ensure accuracy you must mail an ORIGINAL PERSONAL VOID CHEQUE.
It is understood that:
This banking information will be used solely for the purpose of depositing claim reimbursements.
This information will be held in the file of the company for which you are employed.
AVP Financial Corp. reserves the right to pay employee reimbursements by cheque at any time.
It is the sole responsibility of the employee to ensure the accuracy of the banking information provided above.
Any subsequent changes in banking information must be reported in a timely fashion.
AVP Financial Corp. may terminate payment by Direct Deposit without prior notice or authorization from the employee.
If you wish to receive notification of deposit via email, please provide an email address below. Otherwise, notification will be mailed.
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Employee Signature
Employee Email
Date
AVP Health & Welfare Trust
222, 855 - 42 Avenue SE
Calgary AB T2G 1Y8
Questions?
Call: 403.214.3213 or 888.214.3211
Toll Free Fax: 866.213.5514
E-mail:
info@bizflex.ca
www.bizflex.ca