Direct Deposit Authorization
| Foreman Office O: 870.542.6464 F: 870.542..6499 215 N. Madden Street P.O. Box 445 Foreman, AR 71836 |
Ashdown Office O: 870.898.2107 F: 870.667.7127 251 Federal Street P.O. Box 96 Ashdown, AR 71822 |
Fields marked with an * must be completed or form will not submit.
Part 1: Transaction Type
Check the Appropriate box(es).
NOTE: The payee must review Part 2 and complete Part 3 for all Transaction Types
NEW SETUP - Select if payee is not currently on direct deposit.
- The payee or financial institution representative must complete Part 4.
CANCELLATION - Select if payee wants to stop direct deposit.
- Do not complete Part 4.
CHANGE FINANCIAL INSTITUTION
- The payee or NEW financial institution representative must complete Part 4.
CHANGE ACCOUNT NUMBER
- The payee or financial institution representative must complete Part 4.
CHANGE ACCOUNT TYPE
- The payee or financial institution representative must complete Part 4.
