Pediatric Healthcare Connection - Authorization Direct Deposit


I authorize Pediatric Healthcare Connection (PHC) to deposit my pay automatically to the account(s) indicated below and, if necessary, to adjust or reverse a deposit for any payroll entry made to my account in error. This authorization will remain in effect until I cancel it in writing and in such time as to afford PHC a reasonable opportunity to act on it.


Account Type:
Amount to deposit:
Pay balance to:
*Split not available for contractors
Account Type:

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