Type of account (one
box must be checked):
!
Name and location (City, State) of bank Fiduciary's phone number
US/SS Independent Treasury - Electronic Transfer
Checking Savings
Fiduciary's shown on Account Fiduciary's
Identifying number
1 Method of deposit (one box must be checked)
Direct Deposit Fedwire
2 US/SS Independent Treasury Routing number (must be nine digits include the hyphens).
Department of the Treasury
Internal Revenue Service
3 Deposit
Account number (include hyphens but omit spaces and special symbols): 4
Treasury Direct Express Debit Card
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