Enclosure 10 EFT form.pdf

I, hereby, authorize the U.S./ Army Corps of Engineers, hereinafter called USACE, to initiate direct deposit credit entries to my (our) account indicated below and the financial institution named below, hereinafter called DEPOSITORY, to credit the same to such account. This authority is to remain in full force and effect until USACE has received written notification from me (or either of us) of its termination in such time and in such manner as to afford USACE and DEPOSITORY a reasonable opportunity to act on it.

Check one: I am not currently participating in the Direct Deposit Program.

ADD – Deposit my payment to the account shown.

I am currently participating in the Direct Deposit Program. Installation EROC: M2 CHANGE – Change financial institutions and/or account number.

CHANGE – Change address CANCEL – Stop my participation in the program.

*NOTE: PLEASE BE SURE THE NAME AND ADDRESS SHOWN FOR THE BELOW MATCHES THE NAME AND

ADDRESS FOUND IN PARAGRAPH 3 OF THE LEASE. PLEASE SIGN AND DATE FORM AND RETURN

ORIGINAL TO THE GOVERNMENT.

Name (Individual or Company):

Address:

City:

State:

Zip:

Daytime Phone:

Please ask your Financial Institution for your Depositor Account Number and Routing Number

(Indicate which type account to credit)

Type of Depositor Account Please check a box.

Checking Savings

Depositor Account Number

Name of Financial Institution:

Address:

City:

State:

Zip:

Routing Number:

Depositor Account Title:

Tax ID Number (TIN) for Business:

Lease No.:

DACA63-5-

SIGNATURE: ______________________________ DATE: _______________

Enclosure 11, DACA63-5-14-0069