Yukon Direct Deposit Form

YMA Direct Deposit Form

All reimbursement payments are made by direct deposit. Please upload either of the following for setting up payment: (1) a direct deposit document downloaded from your bank site, OR (2) a high quality smartphone image of a void cheque.
Any questions can be directed to:

Fund Manager, Yukon Medical Association
5 Hospital Road, Whitehorse, YT Y1A 3H7
funds@yukondoctors.ca
Full Name

First NameLast Name
Preferred Contact Email
Preferred Contact Number
Format: (000) 000-0000.
Payments made to:
Professional corporation name if you have one.
Address associated with your bank account (residence or business, etc.)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tip: If using a phone, for best quality, take a photo with your phone camera first, then upload from your photo library. This dramatically reduces blurry receipts. Please upload any receipts or documents here.

All reimbursement payments are made by direct deposit. Please upload either of the following for setting up payment: (1) a direct deposit document downloaded from your bank site, OR (2) a high quality smart phone image of a void cheque.
Cancelof
Any other information (optional)
Signature
Date Signed

MonthDayYear
Date
Any feedback on this or any of the YMA forms welcomed and appreciated to funds@yukondoctors.ca
Should be Empty:

YMA Direct Deposit Form