Scribd
Upload
64 views1 page

Direct Deposit Form VT

The document provides instructions for landlords to sign up for direct deposit payments from the Vermont Emergency Rental Assistance Program (VERAP). It includes a form for landlords to fill out with their contact and bank account information to receive electronic rental assistance payments from VERAP.

Uploaded by

Kim Tran
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
64 views1 page

Direct Deposit Form VT

The document provides instructions for landlords to sign up for direct deposit payments from the Vermont Emergency Rental Assistance Program (VERAP). It includes a form for landlords to fill out with their contact and bank account information to receive electronic rental assistance payments from VERAP.

Uploaded by

Kim Tran
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Vermont Emergency Rental Assistance Program

PO Box 199
Manchester, VT 05254-0998
833-4VT-ERAP (833-488-3727)

Direct Deposit Authorization


Please login to the VERAP landlord portal at: https://verapownerportal.reframeassist.io/#/auth/login and upload this
completed document.

PART 1: Transaction Type

✔ New Setup Change financial institution


Cancellation (Leave Part 4 Blank) Change account number
Other Change account type

PART 2: Payee Identification ___ I would like to receive correspondence via e-mail.
Tax ID (Social Security Number or Employer Identification Number) Work Phone Number Home Phone Number

383413310 5185520792 5185520792


Name E-mail Address
SWB LLC swbllc@digdig.org
Address City State Zip Code
2201 14TH AVE APT 5-206 LONGMONT CO 80501

PART 3: Authorization for Setup, Changes, or Cancellation


I hereby request and authorize the Vermont State Housing Authority to deposit payments by electronic funds transfer into the account
specified below and, if necessary, debit entries and adjustments for any amounts deposited electronically in error. I recognize that, if I fail
to provide complete and accurate information on this authorization form, the processing of the form may be delayed or that my
payments may be erroneously transferred electronically.

This authorization will remain in effect until written notice to terminate is given. The undersigned must allow a reasonable amount of
time for initiating or terminating Direct Deposit and is responsible for notification of any change in financial institution information.
Authorized Signature Printed Name Date
BRENDA SORENSON 10/05/2022

PART 4: Financial Institution (Contact your financial institution for this information, if necessary.)
Financial Institution Name City State Zip Code
SUTTON BANK ATTICA OHIO 44807
Type of Account

✔ Consumer Checking
___ ___Consumer Savings ___Corporate Checking ___Corporate Savings

Routing Transit Number: Customer Account Number: 547114615131


041215663

Please make sure all information is correct before sending to VERAP. Incorrect
information may result in a delay or non-payment of VERAP assistance. Including a
voided check with this form is highly recommended to ensure accuracy.

You might also like