Personal Care Agency:	3Care4U
	Agency Address:	P.O. Box 1312, Manitowoc, WI 54220
	Agency Phone Number:	920-663-1225
	Agency Fax Number:	920-614-2004
	Agency Email Address:	[email protected]

Direct Deposit Authorization Form

I hereby authorize 3Care4U to initiate credit entries and, if necessary, debit entries and adjustments for any credit entries in error to my account indicated below.