Boys & Girls Club of Livingston County
Direct Deposit Payment
Name
*
First Name
Last Name
Email
*
example@example.com
Name(s) on Bank Account
*
Bank Name
*
Bank Branch
*
City, State
Routing Number
*
must be 9 numbers - no spaces
Account Number
*
must be 9-12 numbers - no spaces
Account Type
*
Personal Checking
Personal Savings
Business Checking
Business Savings
Other
Payment Type
*
Child Name
*
Beginning Payment Date
*
-
Month
-
Day
Year
Date
End Payment Date
*
-
Month
-
Day
Year
Date
Signature
*
Enter the message as it's shown
*
Submit
Should be Empty: