Direct Deposit Enrollment

Direct Deposit Enrollment
Abbit Master Trust

This form is used to enroll Michigan prepaid sellers/providers in electronic deposit for their prepaid proceeds from death claims. Direct deposit is a safer, faster alternative to sending checks via mail. A VOID check or bank statement is needed to validate this request.

Seller/Provider Name

Seller/Provider Code #

Seller/Provider Address

Street Address

Street Address Line 2

CityState

Zip Code

I hereby authorize Abbit Management Corp. and Fiduciary Partners to directly deposit the proceeds from prepaid accounts which have been established by the above referenced Provider, and terminated due to death, into our bank account listed below. This authorization will remain in effect until written cancellation of authorization is submitted to Abbit Management Corp.

Financial Institution Name

Routing Number

*The first group of numbers printed at the bottom of a check.

Account Number

*The second group of numbers printed at the bottom of a check.

Financial Institution Address

Street Address

Street Address Line 2

CityState

Zip Code

This authorization must be accompanied by a copy of a VOID check or complete bank statement of the account.

Please upload a VOID check or include a bank statement that shows clear reference to the bank name, account number, and routing number.

Signer's Legal Name

Print your legal name.

Signer's Title

You must have authority to enter into this agreement.

Signature