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Pierce County Housing Authority
Tacoma, Washington        253.620.5400

 
Vendor Direct Deposit Authorization Form

Business Opportunities
  

Complete the following form to authorize electronic deposits.

Vendor Direct Deposit Authorization             * denotes required field

 

If you prefer to print and mail this form, click here for a (pdf)
copy of the Vendor Direct Deposit Authorization form.

Business Name*

Tax ID Number*

Remit to Address*

Remit to City*

Remit to State*

Remit to Zip*

Contact Name*

Contact Title*

Contact Phone Number*

Contact Email Address*

Bank Name*

Bank Phone*

Account Type*

Checking Savings

Bank Routing Number*

Bank Account Number*

Authorization*

I am authorized and permit Pierce County Housing Authority to deposit payments by electronic funds transfer into the bank account identified on this form and, if necessary, make debit entries and adjustments for any amounts deposited in error. I agree not to hold Pierce County Housing Authority responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution
This authorization will remain in effect until written notice to terminate is received. The individual submitting this form must allow a reasonable amount of time for initiating or terminating Direct Deposit, and is responsible for notification of any change in financial institution information.

* To ensure your payments are directed correctly, please check with your bank to verify the information you provide is correct.
 
Please enter the phrase as it is shown in the box above.  
      
 
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