Form 14305 - Direct Deposit Form May 2014 (Page 2 of 2) in pdf

Form 14305 - Direct Deposit Form May 2014 Page 2

Adult or Sponsor’s Name (First, Last)

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Direct Deposit Instructions

The routing number is always the first set of 9 digits on the bottom of your check starting from the left. If you are unsure of the routing

number, contact your financial institution directly.

The account number is typically the second series of digits on the bottom of your check starting from the left. Enter the account number

starting on the left side, without dashes or other characters.

For example, if your account number is 123-4567890, you should enter your account as:

Enter the Account Number

1 2

7 8 9

Start account number from this side

Requests with incomplete or incorrect information will not be processed.

If you are unsure of the account or account number, contact your financial institution.

Sec on E: Notary (if required by Sec on A)

State of ____________________________

___________________________________, being by me duly sworn, personally appeared before me and signed this document.

Name of Requestor

___________________________________

Signature of Requestor

Subscribed and sworn before me by _________________________________________ this ________________ day of

Name of Notary Public

________________, 20_____.

__________________________________________________

Notary Seal

Signature of Notary Public

Sec on F: PFD Division Representa ve (if required by Sec on A)

_______________________________________ appeared before me with picture iden ﬁca on.

Name of Requestor

_______________________________________________

___________________________

Date

Signature of PFD Division Representative

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Form 14305 - Direct Deposit Form May 2014 Page 2