Leadership Team Development
3209 Gresham Lake Road Suite 153
Raleigh, NC 27615
Direct Deposit Agreement Form
I hereby authorize Leadership Team Development to initiate automatic deposits to my account at the financial
institution named below. I also authorize Leadership Team Development to make withdrawals from this
account in the event that a credit entry is made in error.
Further, I agree not to hold Leadership Team Development responsible for any delay or loss of funds due to
incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of
my financial institution in depositing funds to my account.
This agreement will remain in effect until Leadership Team Development receives a written notice of
cancellation from me or my financial institution, or until I submit a new direct deposit form to the Accounting
Leadership Team Development has strict security measures in place to protect the loss, misuse and alteration of
the information under our control.
LTD Number: __________
Name of Financial Institution:
Authorized Signature (Primary):
Authorized Signature (Joint):
Please attach a voided check and return this form to the Accounting Department via mail or facsimile to