Direct Deposit Authorization Form

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I authorize Community Action Network to initiate credit (deposit) entries and, if errors occur, I authorize the correction of entries to my account as indicated.
I understand that I may discontinue this authorization at any time by giving written notice to Accounting.
I acknowledge this information will be used solely for the purpose of direct deposit.
I authorize the full deposit of my net income* acquired by Community Action Network.

*Net income: Remaining dollar amount after all taxes, voluntary deductions, and other bank account amounts have been deducted.

First Name

Last Name

Account Type

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Bank or Institution

Bank Routing Number (ABA #)

Bank Account Number

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