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
Street Address
City / Town
Postal Code
Phone Number
Section 2 Banking Information
Name of Financial Institution
Vancity Credit Union
Branch Phone Number
Branch Address
Transit Number
Account Number
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.
Member Name
Date (yyyy-mm-dd)
Internal Use Only
Vancity verification of account.
Employee Name
Employee Number
Date (yyyy-mm-dd)
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