Per-Capita Direct Deposit

Per-Capita Direct Deposit

If you encounter issues submitting this application through your mobile browser, download the SmartSheet app (it's free) or use a desktop or laptop computer. https://apps.apple.com/us/app/smartsheet-teams-projects/id568421135 https://play.google.com/store/apps/details?id=com.smartsheet.android&hl=en_US&gl=US If you want a copy of your submission, remember to check the box at the end of the application.

All changes must be turned in by the 3rd Friday of the month.

The Direct Deposit will go through fully when you turn this in by the 3rd Friday of the Month.

Last Name:

First Name:

Middle Initial:

Suffix:

Date of Birth:

Social Security Number:

Tribal ID Number:

Phone Number:

Email Address:

Please select one of the following:

Checking

Savings

Account Number:

Routing Number:

Banking Name:

Bank's City and State

Would you like your direct deposit information to go to Accounting?*

Yes

Enrollment Authorization

Please enroll me in the Direct Deposit Program. I authorize the Puyallup Tribe's Per-Capita Department to make payments of my net pay be initiating credit entries or correct entries to the bank account I've designated above. I also understand that this authorization will continue in force unless discontinued by my written request and it is my responsibility to maintain the designated account as open to prevent rejected or returned entries.

Applicant Digital Signature:*

By my signature below, I declare that all of the above statements are true and accurate. Withholding information, false information/altered documents will result in immediate denial.

Today's Date:*

File Upload: Upload Voided Check and Tribal ID*

Please upload a voided check, deposit slip or other document showing your bank (transit) routing number and bank account in addition to a valid and an up-to-date Tribal ID card or Government Issued ID for identification purposes.

Drag and drop files here or

This information collect on this form wil lbe used for the Puyallup Tribe's Per-Capita Department and Benefits. Protection from further disclosure will be in accordance with the Puyallup Tribe's Per-Capita Ordinance.

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