952-701-007 (8-2018) Page 1 of 1
BMO FUNDS DIRECT DEPOSIT
AUTHORIZATION
For help with this authorization, or for more information, call us toll-free at 1-800-236-FUND(3863) or 414-287-8555.
1. To be Completed by the Employee
To establish Payroll Direct Deposit, please provide the following information.
_______________________________________________________________________________________________________________
Name
(rst, middle initial, last)
_________________________________________________________ __________________________________________________
Employee Social Security Number Daytime Telephone Number
_______________________________________________________________________________________________________________
Employer Name
_______________________________________________________________________________________________________________
Employer Address
_________________________________________________________ ______________________ ________________________
City State Zip Code
Please indicate your existing account number for the BMO Fund(s) in which you are establishing Payroll Direct Deposit and indicate the
amount to be invested.
Name of BMO Fund Account Number Amount ($50 min) per Pay Period
$
$
$
$
$
$
$
Total $
I hereby authorize my employer, named above, to make periodic investments into the BMO Fund(s) as indicated.
I understand I may terminate this agreement by written notication to my EMPLOYER. Any such notication will be ef
fective only after the
employer has reasonable time to act.
___________________________________________________________________________
_________________________________
Employee Signature Date
2. To be Completed by the Employer or Agency Initiating Payment
_____________________________________________________ _____________________________________________________
Employer Tax I.D. Number (ACH Required) Transit Routing Number
_____________________________________________________ _____________________________________________________
Coding Number Cross Reference Number (To be completed by BMO Funds)
Notice to Employer or Agency - for ACH purposes, code this as a checking account.
3. Mailing Information
Regular Mail: Overnight Mail:
BMO Funds – U.S. Services
P.O. Box 219006
Kansas City, MO 64121-9006
BMO Funds – U.S. Services
430 W 7th Street Suite 219006
Kansas City, MO 64105-1407
01100002-8
99048514
