Hap Electronic Funds Transfer (Direct Deposit) Application Form - Detroit Housing Commission

HAP Electronic Funds Transfer (Direct Deposit) Application

S8 Landlord

The following information must be completed to initiate your monthly HAP payment.

Please attach a voided check or an

authorized letter from your financial institution. RETURN TO: 2211 ORLEANS, ATTENTION: FINANCE TECH, DETROIT MI

313 392-9254

48207 OR FAX TO

OR 313-393-3229

(Please Print All Information)

-

-_______

Landlord s Name________________________________ Social Security Number

Company Name (If Applicable) _________________________________ Tax ID # _____-______________

Mailing Address ______________________________________Telephone No. (_____)_______________

City ______________________State___________ Zip Code ___________

E-Mail address: ____________________________________@______________________

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New

Change

(check one box)

Bank Name : _________________________________________________________________________

Checking

___________________________________

__

Savings

.

Bank Routing Number

Bank Account Number

1234

John and Mary Jones

For a CHECKING account:

123 Main Street

Write VOID on an unused

Anytown, MI 48888

check and attach here.

Pay to:

$ _____________

For a SAVINGS account:

Contact your bank and

VOID - -VOID - - VOID - - VOID - - VOID - - VOID - - VOID

DOLLARS

obtain written verification of

Anytown Bank

your account and routing

Anytown, MI 48888

numbers. Attach that

verification to this form.

For:

Do not complete shaded Area

I : 0 7 2 1 2 3 4 5 6 I : 0 0 1 2 3 4 5 6 7 8 9 0

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Routing Number

Account Number

(9 digits)

(up to 17 digits

Please complete this section if this is a change

Old Routing Number__________________________ Old Account Number__________________________

I authorize the Detroit Housing Commission to deposit my Housing Choice Voucher Rental Payment by electronic transfer into the designated financial institution and

account(s). I understand this authorization remains in effect until canceled by: (a) me, (b) by my death or legal incapacity; (c) the financial institution; or (d) the Detroit

Housing Commission.

I authorize the Detroit Housing Commission to recover money electronically deposited in my account in error, by adjusting subsequent Housing Choice Voucher

Payments for an amount not to exceed the erroneous deposit amount or by electronically debiting an amount equal to the erroneous deposit. I understand I will be

notified in writing by the Detroit Housing Commission if and when adjustments are being made.

I agree to comply with the Detroit Housing Commission rules about electronic transfers. Michigan law governs electronic fund transactions in all respects except as

otherwise superseded by Federal law. I understand I will be notified if any rule changes are made which affect me.

________________________________________________

_________________________

Landlord s / Authorized Representative s Signature

Date

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

FOR OFFICE USE ONLY:

(do not write below this line)

Date entered into system: __________________________________ By: ______________________________

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