Dts Electronic Funds Transfer (Eft) Form printable pdf download

Dts Electronic Funds Transfer (Eft) Form

DTS ELECTRONIC FUNDS TRANSFER (EFT) FORM

PRIVACY ACT STATEMENT

1974 (P: 93-579). A

HIS INFORMATION IS PROVIDED TO COMPLY WITH THE

RIVACY

CT OF

LL INFORMATION COLLECTED

31 U.S. C 33

CFR 210. T

ON THIS FORM IS REQUIRED UNDER THE PROVISIONS OF

Z AND

HIS INFORMATION WILL BE USED BY

’

THE

REASURY

EPARTMENT TO TRANSMIT PAYMENT DATA

BY ELECTRONIC MEANS

TO THE PAYEE

S FINANCIAL

. F

INSTITUTION

AILURE TO PROVIDE THE REQUESTED INFORMATION MAY DELAY OR PREVENT THE RECEIPT OF PAYMENTS

Directions

If the traveler is a Marine then the unit can submit his or her D937 from 3270 and we can update the

information from that print out. If the Traveler is not a Marine then the Traveler can fill out this form in its

entirety and submit it to the I MEF LDTAs.

Last Name: __________________First Name: ___________________M.I.: ________

SSN: ________________________Rank/Grade: _______/_______Date: ___________

Organization:________________ Unit Telephone:_____________________________

Bank Name: ____________________________________________________________

Account Type:

(Check one)

__________Savings __________Checking

Routing Number:

Must Be Nine Digits

Account Number: ___________________________________________________

Include all suffixes

Reason For Traveler Not Changing Their own Info:

________________________________________________________________________

Traveler’s Signature: _____________________________________________________

AO/RO/CO/ODTA Signature: ____________________________________________

Please Ensure That A Copy Of Your DD577 Is Attached. No Changes Will Be Made

Without This Form.

Dts Electronic Funds Transfer (Eft) Form