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?

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

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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