Direct Deposit Form

Please fill out this form and submit. If you have questions please contact us. See below for a sample check where you can find your bank info. Please contact your bank for this info if you do not have checks.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

Name of Bank

Bank Account #

9-Digit Routing #

Type of Account

Pick one

Message

Is there anything else you need to tell us?

Shareholder's Signature

Seth-De-Ya-Ah Settlement Trust is hereby authorized to directly deposit my funds to the account listed above. This authorization will remain in effect until I modify or cancel it in writing. By filling out this form digitally, I understand that by typing my name here, I am submitting a digital signature.

Date

YYYY