EmailMeForm
AUTHORIZATION FOR DIRECT DEPOSIT
THIS FORM IS FOR DIRECT DEPOSIT OF ENTRY PAYOUT OR REIMBURSMENT.
1 FOR PER FAMILY
Contestant Name
First
Last
Contestant Name
First
Last
Contestant Name
First
Last
Email
Phone
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####
Cell Phone
###
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I (We) hereby authorize Idaho Girls Rodeo Association to initiate credit entries to my (our)
Please check proper depository account indicated below at the depository financial institution name below. I (We) acknowledge that the origination of ACH transactions to my (our) account must comply with provisions of the U.S. Law.
Checking
Savings
Depository Name
Depository City, State, Zip
Routing number
Account Number
This authorization is to remain in full force and effect until Idaho Girls Rodeo Association has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Idaho Girls Rodeo Association and depository a reasonable opportunity to act on it. Please sign below
Signature
Clear
