Imrf Form 1199 - Application For Direct Deposit Page 2
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1
2Required Account Information
Important: The name of the person who will receive the IMRF benefit payments
must be on this account.
IMRF needs you to provide specific account information on the reverse side of this form in
order to set up Direct Deposit:
• Name of your financial institution
• Phone number of the branch you use
• Address of the branch you use
• Your account number
• Your financial institution’s routing number
• Type of account
A routing number is a nine-digit number, and is a completely separate number from your
account number.
If you have a savings or brokerage account, you should call the financial institution
where you have your account to obtain the correct routing number.
If you have a checking account, see the sample below for how to get your account
number and the correct routing number from your blank checks. (Note: If you have
temporary checks, call the financial institution where you have your account to obtain
the correct routing number.)
9676
Mary Member
John Member
123 Main Street
Date _______________________
Anywhere, IL 60606
SAMPLE
Pay to the
$
Order of _____________________________________________________________
__________________________________________________________________________Dollars
Nine-digit
Do not include
Bank of Anywhere
Routing Number
the check number
Anywhere, IL 00000
Account
as part of your account
Number
number. (The check number
is generally printed
For______________________________________
_______________________________
immediately after your
account number.)
I:123456789I:
1122334455 II 9676
Member Service Representatives 1-800-ASK-IMRF (1-800-275-4673)
IMRF Form 1199 (Rev. 07/07)
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