Scribd Logo
Upload

Welcome to Scribd!

  • 70 views

    Payee Information For Automatic Deposit of Payment

    Uploaded by

    OneNation
    This document provides instructions for completing a form to set up direct deposit of payments from the Federal Deposit Insurance Corporation. It requests contact and banking information to deposit payments electronically into a checking or savings account. It also includes a privacy statement regarding the collection and use of the information provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Payee Information For Automatic Deposit of Payment

    Uploaded by

    OneNation
    70 views1 page
    This document provides instructions for completing a form to set up direct deposit of payments from the Federal Deposit Insurance Corporation. It requests contact and banking information to deposit payments electronically into a checking or savings account. It also includes a privacy statement regarding the collection and use of the information provided.

    Original Title

    4531-09

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document provides instructions for completing a form to set up direct deposit of payments from the Federal Deposit Insurance Corporation. It requests contact and banking information to deposit payments electronically into a checking or savings account. It also includes a privacy statement regarding the collection and use of the information provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    70 views1 page

    Payee Information For Automatic Deposit of Payment

    Uploaded by

    OneNation
    This document provides instructions for completing a form to set up direct deposit of payments from the Federal Deposit Insurance Corporation. It requests contact and banking information to deposit payments electronically into a checking or savings account. It also includes a privacy statement regarding the collection and use of the information provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Federal Deposit Insurance Corporation

    PAYEE INFORMATION FOR AUTOMATIC DEPOSIT OF PAYMENT

    INSTRUCTIONS: Complete and return this form to the Federal Deposit Insurance Corporation (FDIC). For additional information
    regarding Direct Deposit, please call the Division of Finance at (703) 562-2565. NOTE: The information collected on this form will
    be used solely to update our administrative records. It does not provide any right to payment or reimbursement for current or
    prior work and is not to be construed as a solicitation for new business. You will continue to receive check payments until the
    FDIC has fully processed this form and confirmed your banking information.
    SECTION I - PAYEE INFORMATION
    NAME OF PAYEE TAXPAYER ID NUMBER TELEPHONE NUMBER

    ( ) -
    STREET ADDRESS

    CITY STATE ZIP CODE

    NAME OF CONTACT PERSON TELEPHONE NUMBER

    ( ) -
    E-MAIL ADDRESS (For forwarding remittances) FAX NUMBER

    ( ) -
    SECTION II - FINANCIAL INSTITUTION INFORMATION
    NAME OF FINANCIAL INSTITUTION TELEPHONE NUMBER

    ( ) -
    STREET ADDRESS

    CITY STATE ZIP CODE

    BANK ROUTING NUMBER (9-digits) BANK ACCOUNT NUMBER ACCOUNT TYPE (Check one)

    Checking Savings

    NOTE: The 9-digit Bank Routing Number and Bank Account Number are found on the bottom of the check. The Bank Routing
    Number is the first sequence of numbers; the Bank Account Number follows.

    SECTION III - AUTHORIZATION


    I/We authorize the Federal Deposit Insurance Corporation (FDIC) to make payments due to me/us by electronic funds transfer to
    the account listed above. I/We will notify the FDIC as soon as possible if my/our account information changes.
    NAME OF AUTHORIZER (Please print or type) TELEPHONE NUMBER

    ( ) -
    SIGNATURE OF AUTHORIZATION DATE

    PRIVACY ACT STATEMENT


    The collection of information you are requested to provide on this form is authorized under the Federal Deposit Insurance Act
    (12 U.S.C. §§ 1819 and 1820). The information is required in order for the FDIC to electronically transmit and process payment
    data to your financial institution. Failure to provide the requested information may delay or prevent the receipt of your payments
    through the Electronic Funds Transfer (EFT) payment process. Disclosure of information on this form by the FDIC may be made
    in accordance with any "routine uses of records" listed in the FDIC's Financial Information System, 30-64-0012.

    FDIC 4531/09 (4-00)

    You might also like