8/14/2019 Direct Deposit Debit Card App

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Debit Card andDirect Deposit Request

Please check the following box for the program(s) you wish to apply for or change account information for:

Consultant #_ _ _ _ _ _ My Name _______________________ Phone # (______)__________________

BOTH If you wish to use the same account information for both the Debit Card and Direct Depositprograms, please check the BOTH box and complete the section below.

Debit Card: New Applicant Change Account Direct Deposit: New Applicant Change Account

Bank Account Number:

Account type: Checking Savings

My Banks Name:

My Banks Phone Number:

Name on Bank Account:

Bank Routing Number:

f you wish to use differentaccount information for the Debit Card or Direct Deposit programs, or need toapply or change account information for only one program, please check the box(es) for the program(s) you

need and complete the section below.

DEBIT CARD New Applicant Change Account

My Banks Name:

My Banks Phone Number:

Name on Bank Account:

Bank Account Number:

Account type: Checking Savings

Bank Routing Number:

DIRECT DEPOSIT New Applicant Change Account

My Banks Name:

My Banks Phone Number:

Name on Bank Account:

Bank Account Number:

Account type: Checking Savings

Bank Routing Number:

New ApplicantPlease allow up to three weeks to receive your embossed debit card in the mail. You may callThe Pampered Chef Express Information System at (800) 449-2433, and select the Financeoption, to retrieve your debit card number approximately five business days upon the receipt ofyour application in the Finance department. Please be advised that ACH (Automated ClearingHouse) transactions do not work with all savings accounts. The Pampered Chef reserves the

right to deny the use of accounts which are not compatible with the ACH system.Change of AccountPlease note: Account changes must be received in writing in the Home Office by theFinance department. You will be notified by Finance when the change is effective. You willnot receive a new debit card. Your current debit card number will remain the same.

This card is the property of The Pampered Chef and must be surrendered upon request.Use of this card signifies agreement with the terms and conditions of The Pampered ChefProprietary Debit Card Program.

Terms and Conditions: 1) The Pampered Chef Proprietary Debit Card can only be usedfor Pampered Chef business; 2) The Pampered Chef will treat all information concerningmy Pampered Chef Proprietary Debit Card as confidential; 3) The account informationI provide on my signed Debit Card request is the account number that will be used for allautomated Clearing House transactions; the voided check or deposit slip is utilized foraccount verification only; 4) If my account has insufficient funds when the debit transaction ispresented, The Pampered Chef Returned (NSF) Check and Debit Card Transaction guidelinefound in the Consultant Business Guide will apply.

New Applicant & Change of AccountDirect Deposits are transmitted to the Federal Reserve Bank on the same day thatcommission checks are mailed. The Federal Reserve Bank is required to transfer theto all financial institutions within 48 business hours; therefore, please allow up to twbusiness days for these funds to actually be credited to your account, as direct depoposting procedures differ from bank to bank.

Completed direct deposit forms must be received in the Home Office by the last daythe current month to be included for the following months transmissions.Failure to paccurate banking information will result in the rejection of direct deposit to your acc

I acknowledge the information I provided to the company on this form is true and co

Signature Date

*Please attach a voided check or deposit slip to this request.*

Request forms received without a voided check or deposit slip will be returned to you unpro

Please return this completed form to:The Pampered Chef

Attn: Finance Department E Payment ServicesOne Pampered Chef LaneAddison, IL 60101-5630or fax to (630) 916-1328

The Pampered Chef, Ltd., 2007 3H468-042007