Officials - Direct Deposit Form (Barrie Women's Hockey Association)

Officials - Direct Deposit Form

Personal Information

Name^*

Required

Address:^*

Required

City:^*

Required

Province:^*

Required

Postal Code:^*

Required

E-Mail Address^*

Required

Example: [email protected]. Your submission will be sent to this address.

Phone #:^*

Required

Example: ###-###-####

Bank Information

NOTE: A VOID CHEQUE OR DIRECT DEPOSIT FORM MUST BE PROVIDED (Please scan and send with your submission of the EFT Authorization Form)

Bank Name:^*

Required

Bank Number:^*

Required

Transit Number:^*

Required

Account Number:^*

Required

Upload Void Cheque or Direct Deposit Form

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 1. Maximum File Size: 4MB.

Authorization

AUTHORIZING SIGNATURE: By signing this document you are authorizing Electronic Funds Transfer Payments from Barrie Women's Hockey Association for Officials (Referee and / or Timekeeper) Fees to be sent to the above account.

Date:^*

Required

Signature:^*

Required

Name:^*

Required

Officials - Direct Deposit Form (Barrie Women's Hockey Association)

Personal Information

Bank Information

Authorization

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