Personal Banking | ATB Financial
ATB Direct Deposit/Debit Form
|Customer/Account Information |
|Name: | | | | | |
| |First | |Middle | |Last |
|Address: | | | | | | | | | |
| |Unit/ Apt # | |Street | | City | |Province | |Postal Code |
|Telephone Numbers: |( ) - | |( ) - | |( ) - |
| |Home | |Mobile | |Alternate |
| |
| |Transit |Institution |Account # |
|ATB Financial: |
|For the purpose of: | Direct Deposit | Direct Debit |
| |
|Company Name: | |
| |
|I, the undersigned: |
|Certify that the information on this form is true and correct |
|Consent to the exchange of this information for the purpose of an electronic funds transfer between ATB Financial and the company/creditor named above |
|Understand that the use, disclosure and storage of this form remains the responsibility of myself and/or the direct creditor/debitor. |
| |
| | |
| |Customer Signature |
| |
| | |
|Stamp Here (if applicable) |
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™ Trademarks of Alberta Treasury Branches.
Page 1 of 1
Form 20914 (07/14)
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