DocRx Account Direct Deposit Form

Patient Health First

DocRx Account Direct Deposit Form

The undersigned acknowledges and agrees that such direct deposits may take one day to show in the above account. If the amount is put in on a Friday, the funds of the direct deposit will not show in the above account until the following Monday.

The undersigned agrees that if he or she closes the above-named bank account, or elects to terminate his or her participation in the Direct Deposit Program, the undersigned shall immediately notify DocRx by completing and delivering a new deposit instruction. If the undersigned fails to notify DocRx of a closed bank account or his or her termination in the Direct Deposit Program, shall be neither responsible nor liable for deposits directed to the above referenced bank account.

Direct Deposits to the above-referenced account should be made effective on: