Dear Agency Director - United Way of Southeastern Connecticut



Information for Electronic Fund Transfer

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|Agency Name: | |

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|Address: | |

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|Telephone: | |

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|Fax: | |

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|Contact Name: | |

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|Email Address: | |

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|Bank Name: | |

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|Bank Address: | |

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|Bank Routing Number: | |

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|Bank Account Number: | |

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|Type of Account: | | | |

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|Bank Contact: | |

Please include a void check or other bank documents to assure the correctness of the bank information. Please fax to: Denise Milette at (860) 464-6362 or mail to:

United Way of Southeastern Connecticut

Attn: Denise Milette

P.O. Box 375

Gales Ferry, CT 06335

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