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Below is a cache of http://www.icmarc.org/ImageCache/pubs/general/directdeposit/directdepositform/directdepositform_2epdf/v1/directdepositform.pdf. It's a snapshot of the page taken as our search engine crawled the Web.
The web site itself may have changed. You can check the current page or check for previous versions at the Internet Archive. Yahoo! is not affiliated with the authors of this page or responsible for its content. DIRECT DEPOSIT AUTHORIZATION FORM Note that electronic direct deposit is currently not available for lump or one-time
payments. If selected with any lump-sum option, a check will be mailed to your
permanent address. If you already receive installment payments by direct de-
posit and select direct deposit on the One-Time Payment Form, your One-Time
payment will be sent by direct deposit. Do not complete this form unless your
bank information has changed and be aware that submitting this form will cause
your payment to be issued as a check. ICMA-RC can only direct deposit to bank
account information already on file. Please contact your bank to confirm this information. Incorrect information will delay electronic deposit
processing. Also, please note that the first payment may be issued as a check rather than an electronic
deposit. All subsequent deposits will be completed electronically. Please attach a voided check or deposit
slip. Financial Institution's Routing Number Financial Institution's Telephone Number ___ ___ ___ ___ ___ ___ ___ ___ ___ (___ ___ ___) - ___ ___ ___ - ___ ___ ___ ___ Type of Depositor Account t Checking t Savings Depositor Account Number ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ (See reverse side for a sample to help you locate your account number on your check or deposit slip.) Name of Financial Institution ________________________________________________________________________ I hereby authorize the VantageTrust Company (hereinafter called the Trust) to credit the above referenced account for
any amount owed to me for retirement benefit payments. This authorization agreement is to remain in full force and effect
until the Trust has received written notification from me of its termination in such time and in such manner as to afford the
Trust and depository a reasonable opportunity to act on it. This authorization agreement may also be terminated by the
Trust. In the event that the Trust notifies the bank that funds to which I am not entitled have been deposited to my account
inadvertently, I hereby authorize and direct the bank to return said funds to the Trust as soon as possible. _________________________________________________________________ __________________ Participant/Beneficiary Signature Date 1 Payee
Information 3 Account
Information 2 Type of
Authorization
(select one) 4 Participant/
Beneficiary
Authorization Use this form to have your benefit payments directly deposited into your bank account.
Please complete a separate form for each employer plan account. ICMA Retirement Corporation P.O. Box 96220 Washington, DC 20090-6220 Toll Free 1-800-669-7400 En Espa
The web site itself may have changed. You can check the current page or check for previous versions at the Internet Archive. Yahoo! is not affiliated with the authors of this page or responsible for its content. DIRECT DEPOSIT AUTHORIZATION FORM Note that electronic direct deposit is currently not available for lump or one-time
payments. If selected with any lump-sum option, a check will be mailed to your
permanent address. If you already receive installment payments by direct de-
posit and select direct deposit on the One-Time Payment Form, your One-Time
payment will be sent by direct deposit. Do not complete this form unless your
bank information has changed and be aware that submitting this form will cause
your payment to be issued as a check. ICMA-RC can only direct deposit to bank
account information already on file. Please contact your bank to confirm this information. Incorrect information will delay electronic deposit
processing. Also, please note that the first payment may be issued as a check rather than an electronic
deposit. All subsequent deposits will be completed electronically. Please attach a voided check or deposit
slip. Financial Institution's Routing Number Financial Institution's Telephone Number ___ ___ ___ ___ ___ ___ ___ ___ ___ (___ ___ ___) - ___ ___ ___ - ___ ___ ___ ___ Type of Depositor Account t Checking t Savings Depositor Account Number ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ (See reverse side for a sample to help you locate your account number on your check or deposit slip.) Name of Financial Institution ________________________________________________________________________ I hereby authorize the VantageTrust Company (hereinafter called the Trust) to credit the above referenced account for
any amount owed to me for retirement benefit payments. This authorization agreement is to remain in full force and effect
until the Trust has received written notification from me of its termination in such time and in such manner as to afford the
Trust and depository a reasonable opportunity to act on it. This authorization agreement may also be terminated by the
Trust. In the event that the Trust notifies the bank that funds to which I am not entitled have been deposited to my account
inadvertently, I hereby authorize and direct the bank to return said funds to the Trust as soon as possible. _________________________________________________________________ __________________ Participant/Beneficiary Signature Date 1 Payee
Information 3 Account
Information 2 Type of
Authorization
(select one) 4 Participant/
Beneficiary
Authorization Use this form to have your benefit payments directly deposited into your bank account.
Please complete a separate form for each employer plan account. ICMA Retirement Corporation P.O. Box 96220 Washington, DC 20090-6220 Toll Free 1-800-669-7400 En Espa
