The City of Winnipeg
DIRECT DEPOSIT APPLICATION FORM
March 2020
Direct Deposit Form - Vendor
FOR OFFICE USE ONLY Date Received:
Confirmed with vendor on: Vendor Number:
Name: Location Number:
Telephone Number: Date Entered:
Please forward completed and signed form to:
The City of Winnipeg
Financial Services – Treasury
Main Floor, 510 Main St.
Winnipeg, MB R3B 1B9
Attention: Supervisor of Treasury
NOTE: Incomplete forms will be returned
Name of Organization/Vendor Address of Organization/Vendor
Cont
act Name Telephone Number City Prov Postal Code
Email Address for Remittance Advices
Signature (Must be signed in ink)
Date
Financ
ial Institution/Bank Address of Financial Institution/Bank
Trans
it/Branch Number Institution Number Account Number
*Att
ach original void cheque as verification of above banking information.
Trans
it/Branch Number Institution Number Account Number
Is acc
ount in Organization/Vendor’s Name? Yes No (If No, application cannot be processed)
Name and Title of Bank Officer Bank Domicile Stamp (Please stamp in space provided)
Addr
ess of Financial Institution/Bank
Telephon
e Number
Signa
ture of Bank Officer
Direct Deposit Application Checklist:
Part 1 completed by Vendor
Attach an original personalized void cheque
If unable to supply an original personalized void
cheque, have Part 2 completed by Financial
Institution/Bank
Return original form (and cheque) to Financial
Services – Treasury office
PART 1: TO BE COMPLETED BY VENDOR
PART 2: TO BE COMPLETED BY FINANCIAL INSTITUTION/BANK