Shareholder Direct Deposit / ACH Authorization for Guaranty Bancshares, Inc.

Shareholder Information
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Shareholder Name*  
Email Address*    
City*   State* Zip Code*  
Authorization Agreement for Direct Deposits (ACH Credits)
Company Name: Guaranty Bancshares, Inc.

I (we) hereby authorize Guaranty Bancshares, Inc. hereinafter called “Company” to initiate credit entries to my (our) checking or savings account at the depository named below, hereinafter called “Depository”, to credit the same to such account.
Checking or Savings?
Depository Name*  
City*   State* Zip Code*  
Routing Number*  
Account Number*  
This authorization is to remain in full force and effect until Company has received written notification of its termination in such time and in such manner as to afford Company and Depository a reasonable opportunity to act on it.
Shareholder Signature*
(Type in your first and last name)
Second Shareholder Signature
(Type in your first and last name)
Tax ID Number*  
Daytime Phone*    
Enter the random code shown below*  
Random Code secret code
By clicking on the "Submit" button below you represent that you are the legal shareholder as represented above. You certify that the above statements are true and correct to your knowledge. You authorize Guaranty Bank & Trust to act on this request and accept the terms stated above in electronic format.