Fillable Printable Direct Deposit Request Form - Alabama

Direct Deposit Request Form - Alabama

Alabama Peace Officers’ Annuity & Benefit Fund

P. O. Box 2186

Montgomery, AL 36102-2186

DIRECT DEPOSIT REQUEST FORM

PRINT YOUR NAME: ________________________________________________

(As It Appears On Your Check)

SOCIAL SECURITY NUMBER __ __ __ __ __ __ __ __ __

ALABAMA PEACE OFFICERS' ANNUITY & BENEFIT FUND MEMBER NO.: __________

(If known)

SIGNATURE: ___________________________________

NAME OF FINANCIAL INSTITUTION: _________________________________

ACCOUNT TYPE: Checking ____ (or) Savings ____ ( Check 1 box only )

ACCOUNT NUMBER: ____________________________

BANK ROUTING NUMBER: __ __ __ __ __ __ __ __ __

( 9 Digit Number - Consult Your Bank )

YOUR DAYTIME PHONE NUMBER: ______________________________

(Include Area Code)

YOUR MAILING ADDRESS: _______________________________________

________________________________________

ATTACH COPY OF VOIDED CHECK HERE

(If direct depositing to Checking Account)