Producer Direct Deposit Authorization Form

Producer Direct Deposit Authorization Form
Name on Account*

First NameLast Name
Entity Name *
Email
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Bank
9-Digit Routing #*
Account #*
Re-Enter Account #*
ACCOUNT #'S DO NOT MATCH. YOU WILL NOT BE ABLE TO SUBMIT UNTIL ACCOUNT #'S MATCH. PLEASE VERIFY.
Attach an image of a voided check for which funds should be deposited (if necessary)

Browse Files

Cancelof
Please check this box if you prefer statements emailed to you.

Emailed Statements
I (we) hereby authorize Commonwealth Gin to directly deposit my cotton proceeds to the financial institution/ account listed above.

This authorization will remain in effect until I modify or cancel it in writing.
Signature*
Please verify that you are human*
Should be Empty: