Direct Deposit Computershare Form PDF Details

In the realm of financial management for shareholders, the Direct Deposit Computershare form plays a pivotal role in streamlining the process of receiving dividends. This form serves as an authorization document allowing Computershare, acting as a disbursing agent for various companies, to directly deposit dividend payments into shareholders' bank accounts, either savings or checking. To ensure accuracy and security, the form requires detailed information, including the shareholder's name, address, holder account number, and specific financial institution details such as the account and routing numbers. Importantly, it emphasizes the use of numeric formats for these numbers and cautions against the use of credit card numbers, offering guidance for verification through financial institutions if needed. Additionally, the form distinguishes between checking and savings accounts, requiring names as they appear on the account for verification purposes. A noteworthy feature of this service is its cost-efficiency and convenience, eliminating issues like lost, delayed, or stolen checks and ensuring funds are available on the dividend payable date. The completion process is designed to be user-friendly, guiding shareholders on how to fill out the form correctly to facilitate this electronic transaction method. By requiring signatures and providing space for contact information, the form not only secures authorization but also facilitates communication and verification, reflecting a significant advancement in the direct deposit process and highlighting the benefits of transitioning to electronic dividend payments.

QuestionAnswer
Form NameDirect Deposit Computershare Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namescomputershare direct deposit form, direct credit form computershare, computershare direct deposit forms, deposit computershare

Form Preview Example

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Name

Address

City, State, Zip

Use a black pen. Print in

CAPITAL letters inside the grey A B C 1 2 3 X areas as shown in this example.

+

Computershare Shareholder Services, Inc.

250 Royall Street

Canton Massachusetts 02021

www.computershare.com

HolderAccount Number

__ __ __ __ __ __ __ __ __ __ __

Company Name

___________________________________

Authorization for Electronic Direct Deposit

Account Number

Bank Routing Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Note: DO NOT USE YOUR CREDIT CARD NUMBER. If you are unsure of your Bank Routing Number or account number, please check with your financial institution, or see reverse. Account numbers must be in numeric format.

Checking Account

Savings Account

Name(s) that appear on the account at your financial institution

Name of Financial Institution

I/We hereby authorize Computershare as disbursing agent for the payer, to initiate dividend credit entries to my (our) account; or if necessary debit entries or adjustments for any credit entries in error. This authority is to remain in effect until my (our) written authorization to terminate direct deposit is received in time to afford Computershare reasonable opportunity to act on it or until this service is terminated by the payer or Computershare. All registered shareholders as well as all individuals listed on the financial account must sign below.

Signature 1 - Please keep signature within the box.

 

Signature 2 - Please keep signature within the box.

 

Date (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Daytime Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please return completed form to:

Computershare

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PO Box 43078

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Providence RI, 02940-3078

 

 

 

 

 

 

 

 

 

 

 

 

 

E 1 U D D

+

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

00H7WC-WEB

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How to complete this form

Print the complete bank account number.

Print the bank routing number from your check or savings deposit slip.

Indicate the type of account: checking or savings.

Print the name in which the account is held as it appears on your check.

Print the complete name of your financial institution.

Sign, date and print your complete phone number.

Return in the envelope provided.

The Benefits

The service is free.

There are no lost, delayed or stolen checks.

The funds are available for your use on the dividend payable date, no delays waiting for the check to clear.

Contact your financial institution to verify deposit of funds on or after payable date.

Your monthly bank statement will reflect the electronic credit.

Name on Bank Account

Financial Institution and Branch Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

John A. Doe

63-858

 

 

Mary B. Doe

670

 

 

123 Your Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Anywhere , U.S.A. 12345

 

 

 

 

 

 

 

 

 

20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAY TO THE

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ORDER OF

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bank of Anywhere

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

123 Main Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Anywhere, USA 12345

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOR

 

 

 

 

 

SAMPLE (NON-NEGOTIABLE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

123456789

12345678901234567

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bank Routing Number

Bank Account Number

00H7YB

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1. While completing the direct credit form computershare, make sure to include all of the needed blank fields in its associated part. It will help to speed up the work, making it possible for your information to be processed promptly and appropriately.

Filling in part 1 of direct deposit computershare

2. When this part is complete, you have to insert the needed specifics in Names that appear on the account, Name of Financial Institution, IWe hereby authorize Computershare, Signature Please keep signature, Signature Please keep signature, Date mmddyyyy, Daytime Telephone Number, Please return completed form to, E U D D, HWCWEB, and Computershare PO Box Providence allowing you to move forward to the 3rd stage.

Signature Please keep signature, Name of Financial Institution, and Signature Please keep signature of direct deposit computershare

Those who use this document often make mistakes while completing Signature Please keep signature in this section. Remember to revise whatever you type in right here.

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