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Money Manager Card Enrollment Form

First Name: _________________ Last Name: _________________

SS #:______________________ Date of Birth: _______________

Secret Word: _________________________ (For security purposes you will be asked by Customer Service to provide this secret word. Please choose wisely; 6 -10 characters you will remember but no one else will know)

Mailing Address: ____________________________________________________________

City: ________________________________ State: __________ Zip:________________

Telephone: (Home) ____________________ (Mobile) ____________________________

Email Address: _______________________ @ ____________________________________

Important! Please read before completing. By signing at the bottom I agree to the following terms:

I, the undersigned, hereby authorize Temporary Personnel Services, Inc (TPS, Inc) and their payroll company to initiate account transactions to deposit my employee pay directly into my Money Manager Card account, and change the deposit of any amounts owed me.

I understand that it may take two pay periods in order to change the deposit amount. In the event the payroll company deposits funds erroneously into my account, I authorize the payroll company to debit my account for an amount not to exceed the original amount of the erroneous credit. This authorization is to remain in effect until the payroll company has received written notification from me of its termination in such time and manner as to afford the payroll company reasonable opportunity to act on it.

By signing below, I also recognize that as a Money Manager Card account holder, I, and not my employer, am responsible for the card and its subsequent account transactions. The loss/theft of the card I will report to Customer Service as outlined by the cardholder Terms and Conditions. I also accept and authorize the re-issuance and shipping cost be deducted directly from my MMC account in the event a replacement card is required.

Employee Signature: _____________________________ Date: __________

TPS, Inc Representative:_______________________ Location:___________________