Tax Refund Deposit Authorization, University National Bank Privacy Notice printable pdf download

TAX REFUND DEPOSIT AUTHORIZATION

Taxpayer’s Name________________________________

Social Security No. ______________________________

Spouse’s Name__________________________________

Social Security No. _______________________________

As used herein, the terms “you” and “your” refer to the person signing below as the “Primary Taxpayer” (or, if a joint

return is being filed, both the “Primary Taxpayer” and “Spouse”). The terms “BANK,” “we” and “our” refer to University

National Bank, a nationally chartered bank located in Saint Paul, MN. By signing below, you authorize BANK to receive

a direct deposit of your refund from the IRS and/or state taxing authorities. You authorize BANK to deduct the following

from your refund(s):

Expected Federal Refund

$_________

Deductions:

Tax preparation fee paid to your tax professional

$_________

Amount paid to you

$_________

You want the balance of your refund(s) deposited to the following account:

RTN _________________________ DAN _____________________________________________

Notice: If your bank account information is entered incorrectly and your deposit is returned to BANK, the refund balance

will be disbursed to you via a cashier’s check mailed by BANK to the address on your tax return. If the deposit is not

returned to BANK, you will be responsible for the loss.

You understand that the amounts given above are estimates and that neither BANK nor your tax preparer can guarantee the

amount of the refund that will be deposited by the IRS and/or state taxing authority. If your tax refund is not received, you

will still owe your tax preparer for preparing and filing your tax return.

_________________________________________________ _________________________________________________

Primary Taxpayer Signature

Date

Spouse’s Signature

Date

The Federal Electronic Fund Transfer Act provides you with certain rights and obligations regarding the electronic transfer

of your tax refund by BANK. If you believe that there is an error concerning the processing of your refund, write to

University National Bank, P.O. Box 261639, San Diego, California 92196 or telephone (800) 901-6663 and provide BANK

with your name, a description or explanation of the error and the dollar amount of the suspected error. BANK will advise

you of the results of its investigation within 10 business days.

___________________________________________________________________________________________________

PRIVACY NOTICE: Please see the privacy notice at the end of this Agreement.

SCB_7768_9_6_2011

Tax Refund Deposit Authorization, University National Bank Privacy Notice