Direct Deposit Authorization Form
Complete this secure form to authorize the Woman's Exchange of Memphis to deposit consignor payments directly into your bank account.
Full Legal Name
*
Business Name, if applicable
Consignor Number or Code
Mailing Address
*
City, State and ZIP Code
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Name of Financial Institution
*
Name Listed on the Bank Account
*
Account Type
*
Checking
Savings
Nine-Digit Bank Routing Number
*
Confirm Bank Routing Number
*
Bank Account Number
*
Confirm Bank Account Number
*
I confirm the information is accurate and authorize direct deposit.
*
I agree
Electronic Signature (type full legal name)
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: