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    Wisely Pay Card Form 2

    Uploaded by

    Lesly Rodriguez
    The document is a wage payment election and consent form for an employee to choose direct deposit of wages to an ADP Wisely Pay card and consent to the terms. The employee provides their information and elects to receive 100% of their net pay deposited to the Wisely Pay card each pay period. They acknowledge reading and agreeing to the cardholder agreement and fee schedule. The form also includes information required by law to help fight terrorism and money laundering when opening a prepaid card account.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Wisely Pay Card Form 2

    Uploaded by

    Lesly Rodriguez
    41 views2 pages
    The document is a wage payment election and consent form for an employee to choose direct deposit of wages to an ADP Wisely Pay card and consent to the terms. The employee provides their information and elects to receive 100% of their net pay deposited to the Wisely Pay card each pay period. They acknowledge reading and agreeing to the cardholder agreement and fee schedule. The form also includes information required by law to help fight terrorism and money laundering when opening a prepaid card account.

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    The document is a wage payment election and consent form for an employee to choose direct deposit of wages to an ADP Wisely Pay card and consent to the terms. The employee provides their information and elects to receive 100% of their net pay deposited to the Wisely Pay card each pay period. They acknowledge reading and agreeing to the cardholder agreement and fee schedule. The form also includes information required by law to help fight terrorism and money laundering when opening a prepaid card account.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    41 views2 pages

    Wisely Pay Card Form 2

    Uploaded by

    Lesly Rodriguez
    The document is a wage payment election and consent form for an employee to choose direct deposit of wages to an ADP Wisely Pay card and consent to the terms. The employee provides their information and elects to receive 100% of their net pay deposited to the Wisely Pay card each pay period. They acknowledge reading and agreeing to the cardholder agreement and fee schedule. The form also includes information required by law to help fight terrorism and money laundering when opening a prepaid card account.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    WAGE PAYMENT ELECTION AND CONSENT FORM

    EMPLOYEE INFORMATION (print and complete all fields)

    First Name Middle Initial Last Name


    Victoria E Vargas Perez
    Date of Birth (mm/dd/yyyy) Social Security Number Employee ID
    08 / 03 / 1994 627 – 44 – 9627 800516317

    Legal Address (No PO Box) Apt # (if applicable)


    15700 e alameda parkway 304

    City State Zip Code


    Aurora CO 80017
    Home Phone Mobile Phone Email Address
    ( ) – (720) 461–4884 [email protected]
    Mailing Address (optional) Apt # (if applicable)

    City State Zip Code

    Home Phone Mobile Phone Email Address


    ( ) – ( ) –
    WAGE PAYMENT ELECTION

    ✘ Wisely Pay by ADP card (indicate amount of deposit)

    ✘ Full Deposit: I want to receive 100% of my full net pay on my Wisely Pay card every payday

    I confirm my authorization to be paid through the Wisely Pay by ADP card is fully voluntary. I acknowledge I have
    received and read the Wisely Pay card Fee Schedule, Cardholder Agreement, and Privacy Notice. I understand that in
    order to use the Wisely Pay card, I will need to accept and agree to the Cardholder Agreement and to pay the fees as
    indicated on the Fee Schedule by activating my Wisely Pay card. By electing Wisely Pay card as my wage payment
    choice, I am consenting to provide my personal information to ADP to enroll in and request a Wisely Pay card.
    IMPORTANT INFORMATION ABOUT APPLYING FOR A NEW PREPAID CARD ACCOUNT - To help the government
    fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify,
    and record information that identifies each person who opens an account. What this means for you: When you open a
    Prepaid Card account, ADP may require your name, address, date of birth, Social Security number, tax identification
    number and other information that will allow ADP to identify you. ADP may also ask to see your driver's license or other
    identifying documents. You will not be subject to a credit check.
    CONSENT TO DEPOSIT WAGES
    I authorize my employer (or its payroll service provider) to initiate credit entries each pay date to deposit my pay (either
    net or a portion thereof) into the Wisely Pay card account selected in this election and consent (the “Account”). If funds to
    which I am not entitled are deposited to my Account, I authorize my employer (or its payroll service provider), to initiate
    any action to reverse or correct an erroneous credit entry to my Account and to direct the bank to return said funds to my
    employer (either directly or through its payroll service provider), to the extent permitted by applicable law. I will review my
    pay statement to ensure that my wages are being deposited correctly into my Account each payroll period. I understand
    that I can change my election at any time by contacting my employer and that this authorization replaces any previous
    authorizations and will remain in full force and effect until my employer (or its payroll service provider) has received written
    notification from me of its termination and my employer (or its payroll service provider) and the bank has had a reasonable
    opportunity to act on said termination.

    Employee Signature Date


    Victoria Esmeralda Vargas Perez 09/25/2023

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