Direct Deposit Authorization

Direct Deposit Authorization

Please complete this form and return to:
Housing Authority of the County of Merced; Attn: Mila Zimina; 405 U St; Merced, CA 95341

Please print clearly.

Part 1: Transaction Type

Part 2: Payee Identification

Part 3: Authorization for Setup, Changes, or Cancellation

I hereby request and authorize The Housing Authority of the County of Merced to deposit payments by electronic funds transfer into the account specified below and, if necessary, debit entries and adjustments for any amounts deposited electronically in error. I recognize that, if I fail to provide complete and accurate information on this authorization form, the processing of the form may be delayed or that my payments may be erroneously transferred electronically.

This Authorization will remain in effect until written notice to terminate is given. The undersigned must allow a reasonable amount of time for initiating Direct Deposit and is responsible for notification of any change in financial institution information or email address or mailing address.

Part 4: Financial Institution

(Contact Your Financial Institution For Questions)