Direct Deposit Authorization

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    I hereby authorize Washington Law Center (full address below) and its associates to direct deposit my time loss, loss of earning power, pension, permanent partial disability, back time loss and time loss adjustments, or any other form of payment or compensation received in for my workers’ compensation claim, in to the bank account which I will indicate below. Once this system has been put into place this service will be preformed automatically. I understand it is the client’s responsibility to inform Washington Law Center of any changes to the account or direct deposit information. Should the funds be returned to Washington Law Center for any reason a check will be issued along with the documentation via regular mail to my last known address. This form only authorizes Washington Law Center to make deposits into my account. No other actions are being authorized. Finally, I understand that I can stop this service and have a check mailed out at any time, however, I must inform Washington Law Center of this request three days prior to the arrival of the expected funds. 

    Washington Law Center

    651 Strander Blvd

    Building B, Suite 215

    Tukwila, WA  98188

    Tel:  (206) 596-7888

    Fax: (206) 457-4900

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