Common Contracts
1 similar Direct Deposit Agreement contracts
FPDRDirect Deposit Agreement • July 12th, 2019
Direct Deposit AgreementI hereby authorize the Bureau of Fire and Police Disability and Retirement to deposit my net benefit into the account(s) indicated below. Personal Information Name (printed) Social Security Number (only last four digits) XXX-XX- Primary Account Financial Institution Account Number Account Type (check one) Checking Savings Secondary Account (Optional) If you wish to have a fixed dollar amount (no percentages) deposited to a secondary account, please enter the amount below. The balance of your net check will be deposited to your primary account. Financial Institution Account Number Account Type (check one) Checking Savings Dollar Amount Please be aware that any one-time or special payments will be deposited entirely to the primary account. Signature Date Please attach voided check and mail, fax, or email form to FPDR.
