Per Capita Cancellation of Direct Deposit

Per Capita Cancellation of Direct Deposit

PURPOSE:

For Puyallup Tribal Members to cancel direct deposit of per capita payments.

Puyallup Tribal Member Information

Todays date:*

Who is in need of cancellation of direct deposit?*

Select or enter value

Child's First Name:*

Childs Middle Name:*

Child's Last Name:*

First Name:*

Middle Name:*

Last Name:*

Enrollment #:*

Name of Financial Institution:*

Bank you wish to cancel direct deposit.

Account Number:*

Routing Number:*

I authorize Puyallup Tribe Per Capita to cancel my per capita direct deposit*

I understand this request may take 1-2 payments to take effect.*

Digital Signature

I certify that all the information provided herein is accurate and complete to the best of my knowledge. By signing this form I agree that I am requesting cancellation of direct deposit for myself.

I certify*

Type your full name below for digital signature:*

Send me a copy of my responses

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