010108 02112020 JP
2160 41
st
Avenue, Capitola CA 95010-2040
PH: (831) 454-9455, FAX: (831) 469-3712
Housing Choice Voucher Program (Section 8)
LANDLORD DIRECT DEPOSIT AUTHORIZATION
DIRECT DEPOSIT IS NOW REQUIRED FOR ALL LANDLORDS PARTICIPATING IN THE
SECTION 8 HOUSING VOUCHER PROGRAM
I am hereby requesting that the payments I receive from the Housing Authority of the County of Santa Cruz in
accordance with the Housing Assistance Payments (HAP) contract be made by direct deposit:
IF YOU ALREADY HAVE A DIRECT DEPOSIT UNDER YOUR NAME AND TAX ID # YOU DO NOT
NEED TO SUBMIT A NEW FORM
For all rental units under my tax identification number: #_______________________________________
Account type: Checking Savings
Name(s) on Account: ____________________________________________________________
Bank Routing number: ___________________ Account number: ___________________
To confirm the banking information above, please include a VOIDED CHECK. This authorization will not
be valid unless accompanied by a voided check. Mail or fax to the Housing Authority, attention Finance
Department.
Landlord name: _____________________________________________________
Landlord Address: _____________________________________________________
_____________________________________________________
Phone Number: _____________________________________________________
E-mail address (for payment information): ______________________________________
I understand that any changes to this agreement must be submitted in writing 30 days prior to payment dates.
I hereby authorize the Housing Authority of the County of Santa Cruz to make direct deposit of Housing
Assistance Payments to the above account. This authorization will remain in effect until I give 30 days written
notice to cancel.
Signature: _______________________________ Date: __________________
Print name: ______________________________
