State Street Direct Deposit Form - Exchange printable pdf download

ARMY & AIR FORCE EXCHANGE SERVICE

RETIREE ADMINISTRATION SERVICE CENTER

DIRECT DEPOSIT FORM FOR PENSION PAYMENTS

Retiree Services P.O. Box 24989 Jacksonville, FL 32241-4989

1-877-247-2769 (Toll Free) 1-904-791-2246 (International Number)

FORMS MUST BE RETURNED TO THE SERVICE CENTER BY THE 15

OF THE MONTH

TO BE EFFECTIVE THE FIRST OF THE FOLLOWING MONTH.

Form must be completed by your Bank or Financial Institution

IF FORM IS INCOMPLETE YOUR DIRECT DEPOSIT WILL BE DELAYED

NAME:________________________________________________

SSN:_______-_____-________

Please Print (Last Name)

(First Name)

(Middle Initial)

ADDRESS _____________________________________ CITY ______________ST ____ ZIP ________

PHONE: (

)__________ - ______________

DATE:_______________________

AUTHORIZATION AGREEMENT: I authorize State Street Bank to deposit the pension/annuity payments from

the Army & Air Force Exchange Service Pension Program directly into the account named below. This authority

will remain in effect until I have given written notice that I have terminated it or until I have been notified that this

deposit service has been terminated. I understand that I must give adequate notice to allow reasonable time to act

on my instructions. If ever an incorrect amount should be entered into my account, I authorize State Street Bank to

direct my bank to make the appropriate credit or debit adjustment.

Pensioner Signature:____________________________________

Date:_________________

NOTE: A VOIDED CHECK OR A PERSONALIZED DEPOSIT SLIP MUST BE ATTACHED.

Name of Bank or Financial Institution:_________________________________________________

Branch Address: __________________________________________________________________

City:___________________________ State:______________

Zip Code:_______________

Type of Account:

Special Checking___

Regular Checking___

Savings___

Account Number:______________________________________________

*Transit Routing/ ABA Number: ___ ___ ___ ___ - ___ ___ ___ ___ - ___

*(If Electronic Funds Transfer is not available, please omit Transit Routing/ ABA Number.)

*. We verify the accuracy of the above information and agree to refund to State Street Bank any amounts found to

be overpayments provided the funds are available in the Pensioner’s account.

We verify the accuracy of the above information:

__________________________________________

______________________________

Signature of Bank Officer

Title of Bank Officer

__________________________________________

(

)________ - ____________

Please print Name of Bank Officer

Phone:

Direct Deposit will be through Electronic Funds Transfer unless the bank or financial institution listed above does

not participate in the Automatic Clearing House System or is located outside of the United States. THE FIRST

PAYMENT WILL BE VIA CHECK AND WILL BE MAILED TO BANK ADDRESS ON FILE.

State Street Direct Deposit Form - Exchange

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