Fillable Printable Direct Deposit Agreement Form - Alabama

Direct Deposit Agreement Form - Alabama

DD-1

Electronic

(rev. 09/2012)

OPR: Benefits

M ail to: Alaba ma Dep art ment of Labor

Attn Fund Control Room 5228

649 Monroe Street

Montgomery, Al 36131

ALABAMA DEPARTMENT OF LABOR

AGREEMENT FOR DIRECT DEPOSIT

Please Print

Name Socia l Secur ity Num ber :

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START

STOP

I authorize the Alabama Department of Labor to make automatic deposit of the

full amount of any pay ments of my weekly unemploy ment benefits to my :

□ Checking Account □ Savings Account

(ATTACH VOIDED CHECKS (ATTACH DEPOSIT SLIP)

I authorize the Alabama Department of Labor to terminate the automatic deposit of

payments of unemployment benefits.

I aut ho riz e the Alabama De par tment of Labor to change the automatic deposit of

payments of unemployment benefits according to the changes shown below. I

unders tand that the Alabama Department of Labor c an autom atic all y d eposit unemplo ym ent ben ef its only

to a separate or joint banking account under which the name of the above claimant is listed and that the

Department will not become involved in any disputes regarding the use of funds deposited into joint

accounts.

NAME OF B ANK OR F INANCIAL I NSTITUTION

CITY

STATE

ZI P CODE

BANK ACCOUNT NUM BER

TYPE OF ACCOUNT

□ Checking □ Savings

ROUTING

NUMBER

This authorizati on s hall remain in effect, regardless of the establishment of any subsequent benefit year c laim and unt il the Alabama

Department of Labor has received written notification from me to terminate or otherwise change the automatic deposit of my

unemployment benefits. S uch notificat ion s hall be deli vered in a timel y manner in order to afford the Alabam a Department of Labor

an opportunity to comply. In no event shall any such termination or change affect any unemployment benefits previously processed

by the Alabama Department of Labor for automatic deposit at the time of the notification.

In the event of an error in the automatic deposit of my unemployment benefits to my account, I authorize my named banking

institution to correct the error in my acc ount. I also underst and that all transactions with m y account by the Alabama Department of

Labor s hal l be governed by the Rules of the Autom ated Cleari ng House Association.

I als o underst and th at the Alabama Department of Labor is NOT res ponsibl e for e rrors i n the bank t ransit routing num bers or in the

account number as listed above, and is furt her NOT respon sible in the event that the above selected institution is not part icipat ing in

the Direct Deposit program through the Federal System.

Signature

Date

IO_________

DATE______________

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CHANGE