MORAVIAN CHURCH IN AMERICA, SOUTHERN PROVINCE
MORAVIAN CHURCH IN AMERICA, SOUTHERN PROVINCE
PROVINCIAL TREASURER’S OFFICE
459 SOUTH CHURCH ST
WINSTON-SALEM, NC 27101
[pic]
DIRECT-DEPOSIT SIGN-UP FORM
Name of Payee (last,first,middle initial) _______________________________________
Address ________________________________________________________________
City ___________________________State_________________Zip Code____________
Social Security Number ___ __ ___
Employment Location(Church, Daycare or Agency)______________________________
Type of Depositor Account/Amount: Checking ____________ Savings ____________
Checking Depositor Account Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __
Savings Depositor Account Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __
PAYEE CERTIFICATION:
I certify that I am entitled to the payment identified above. I authorize my payment to be sent to the financial institution named below to be deposited and any adjustments made to the designated account. I can terminate the direct deposit of this payroll arrangement simply by giving written notice.
SIGNATURE___________________________ DATE________________
Name and Address of Financial Institution:
Name_______________________________
Address_____________________________
______________________________
______________________________
.
************************************************************************
(HAVE YOUR BANK FILL IN THE INFORMATION BELOW)
Or: Send back to the Treasurer’s Office with this form a blank void check, savings deposit slip or both if the monies are being split between a checking and savings account
Routing Number Checking: __ __ __ __ __ __ __ __ __
Routing Number Savings: __ __ __ __ __ __ __ __ __
I confirm the identity of the above-named payee and the account number. As representative of the above-named financial institution, I certify that the financial institution agrees to receive and deposit the payment identified.
Signature of Representative__________________________ Date_____________
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- checking account asset verification
- frequently asked questions faq shareworks
- village savings and loan associations vs las in africa
- united nations
- united states of america
- in 1973 bank of america wanted to put their thousand
- porsche club of america
- moravian church in america southern province
- ngpf activity bank ms mcrae s classes home