HomeMy WebLinkAboutCity of St Joseph - direct depositDirect Deposit Agreement Form
I hereby authorize City of Saint Joseph to initiate automatic debits to my account at the financial institution
named below. I also authorize Sentry Bank to make withdrawals from this account in the event that a credit
entry is made in error.
Further, I agree not to hold Sentry Bank or City of Saint Joseph responsible for any delay or loss of funds due
to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part
of my financial institution in debiting funds to my account.
Account Information
Name of Financial Institution:
Routing Number:
Account Number:
Authorized Signature (Primary):
Checking Savings
❑ ❑
Date:
Please attach a voided check or deposit slip and return this form to the City of Saint Joseph.
A UTOMA TIC TRANSFER AUTUORIZATION
Transfer From:
Bank Name:
Bank ABA Number:
Account Name:
Account Number:
Type of Account:
Transfer To:
Bank Name:
Bank ABA Number:
Account Name:
Account Number:
Type of Account:
Amount to be transferred:
Frequency: Weekly Monthly Other
Effective Date:
Termination Date:
Per File Transfer Fee: $-5.00 Fin. Inst. Representative Initials:
I, (We), authorize the Bank to transfer funds as indicated above. I, (We), agree to
maintain sufficient balances to cover such transfers. I, (We), agree the rights of the
Bank with respect to each transfer shall be the same as if it were a withdrawal
personally signed by me (us).
Date: Signature: