Direct Deposit

Housing Choice Voucher Program DIRECT DEPOSIT AUTHORIZATION FORM

I/We hereby request the payments received from the Stanislaus Regional Housing Authority (“the Authority”) in accordance with the Housing Assistance Payment (HAP) contract be made by Direct Deposit. This authorizes the Authority to initiate electronic deposit entries to the bank account shown above. This authorization will remain in effect until participation is terminated in the Housing Choice Voucher Program. By signing this form, I also agree that I will keep my contact information (email address) updated with the Authority, as well as provide in writing to the Authority thirty (30) days prior to payment dates all necessary changes to current financial institution status..
Choose One:*

New Direct Deposit RequestUpdated Direct Deposit Request
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Vendor Number(s)*
THE VENDOR NUMBER CAN BE LOCATED ON THE TOP LEFT HAND CORNER OF YOUR CHECK STUB (EXAMPLE BELOW). PLEASE SEPARATE MULTIPLE NUMBERS WITH A COMMA.
Choose Account Type: Checking OR Savings*

CheckingSavings
Choose One of the following:*

Personal AccountBusiness Account
Name on Bank Account and Tax ID Must Match Payee Name
Name of Financial Institution*
Account Number*
Routing Number*
TAX ID or SSN*
ALL SIGNERS ON BANK ACCOUNT MUST SIGN THIS AUTHORIZATION FORM.
Bank Account Signer #1 - Please Print Signature/Name*

First NameLast Name
Bank Account Signer #2 - Please Print Signature/Name

First NameLast Name
Bank Account Signer #3 - Please Print Signature/Name

First NameLast Name
Email Address (Please note HACS must have a valid e-mail address to send monthly payment statement)*
example@example.com
Please attach image of voided check or Savings Deposit Slip*

Browse Files

Cancelof
Please email DirectDeposit@stancoha.org or call (209)557-2071 with questions, or if further information is required.
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Housing Choice Voucher Program DIRECT DEPOSIT AUTHORIZATION FORM