Authorization Agreement for
Automatic Deposits (ACH) Credits
I hereby authorize Frost Bank, to initiate credit entries and to initiate, if necessary, debit entries and
adjustments for any entries in error to my __ Checking __ Savings account (select one) indicated
below and the Bank named below to credit and/or debit the same account. This
completed document may be faxed directly to Frost Bank at 1-210-220-5577 or sent to the City of
Plano to be forwarded to Frost Bank.
To Be Completed by Retirement Plan Participant
Name of Company for which retirement is received: City of Plano Retirement Security Plan
Participant Name: ___________________________________ Employee ID#:_________________
Social Security Number: XXX-XX- (last 4 digits only)
Address:
City: State: Zip Code:
Bank Name: Telephone #:
Transit/ABA #: Account #:
This authorization is to remain in full force and effect until Frost Bank has received written notification
from me of its termination in such time and in such manner as to afford Frost Bank a reasonable
opportunity to act on it.
Participant Signature: Date:
You may also attach a voided check below.
Revised 1-2020
