DEPOSIT REQUEST FORM
ARKANSAS STATE TREASURY MONEY MANAGEMENT TRUST
Please complete this form and return to the Arkansas State Treasury’s Office via email.
Email: MMTrust@artreasury.gov
Contact: STMMT Administrator (501-682-1291)
Participant Name:
Transaction Date: Request Date: ____________________
Participant's Phone Number:
Participant’s Email:
Deposit Amount:
To STMMT Account #:
From (Bank Name): __________________________________________
Bank Account Number:
Authorized by:
__________________________________________ __________________________________
Signature Title
__________________________________________ __________________________________
Please Print Name Date
__________________________________________________________________
FOR TRUST USE ONLY
Ticket #___________
Correspondent
Bank Name__________________________________________________________
Account BalanceBank T/R #_________________________ __________________
Correspondent Bank T/R#_______________________________________________
