Electronic Fund Transfer (Eft) Authorization For Direct Deposit Form

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Teamsters Joint Council No. 83 of Virginia
Health & Welfare and Pension Funds
8814 Fargo Road ∙ Suite 200 ∙ Richmond, VA 23229
Phone (804) 282-3131 ∙ 800-852-0806 ∙ Fax (804) 288-3530
ELECTRONIC FUND TRANSFER (EFT) AUTHORIZATION FOR DIRECT DEPOSIT
Please complete, sign, and return this authorization to the Fund office. If received at least 7 business days
before the end of a month, the direct deposit will be effective the first of the next month. Benefits are
guaranteed to be in your account by 2PM on the first business day of the month.
Financial Institution ____________________________________________________________________
Address
____________________________________________________________________________
*
Financial Institution’s Routing (ABA) Number
*Your Account Number _________________________________________________________________
Check one:
Checking Account
Savings Account
*
DO NOT GUESS! CONTACT YOUR FINANCIAL INSTITUTION FOR THE CORRECT NUMBERS IF YOU
ARE NOT SURE. [An incorrect number will delay your payment. A common error is including the check
number in the account number.]
Print Your Name ________________________________________________________________________
Your SSN or Alt ID#____________________________________
Your Signature _________________________________________ Date Signed______________________
By completing this form, you authorize the financial institution, at the request of Teamsters Joint Council
No.83 of Virginia Pension Fund, to make any correction entries to your account in accordance with the rules
of such financial institution and/or the rules of Automated Clearing House payments. This authorization will
remain in effect until the financial institution receives written notification that you have cancelled it.
Even if on direct deposit, keep the Fund office advised by written notice of any address change.
Feb 2013

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