Form_0344 (2019-08-30) Page 1 of 1
Banking information for direct deposit
Description of Service:
This form contains the banking information required to facilitate direct deposits to your Vancity account.
Section 1 – Member Information
Full Name or Business Name
Section 2 – Banking Information
Name of Financial Institution
Section 3 – Depositor Information
Organization / Company Setting Up Direct Deposit
Is hereby requested and authorized to make deposits to my/ our account as designated below which are
payments due to me. This authorization may be cancelled or the account number changed by a phone call to
said organization at least one week before payments are due to me.
Section 4 – Authorized Signature
By signing this document, I agree to the terms and conditions set forth in this agreement.
Vancity verification of account.