"Direct Deposit Enrollment Form" - Oklahoma

Direct Deposit Enrollment Form is a legal document that was released by the Oklahoma Department of Labor - a government authority operating within Oklahoma.

Form Details:

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  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Labor.

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Download "Direct Deposit Enrollment Form" - Oklahoma

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Oklahoma Employment Security Commission Direct Deposit Enrollment Form
YOU ARE CURRENTLY ENROLLED IN THE OKLAHOMA DEBIT MASTERCARD
CARD PROGRAM
®
If you would like to sign up for Direct Deposit, you must complete this form and return it to the address
below: Direct Deposit may add
hours for receipt of funds.
• To have your funds directly deposited in your bank account, you MUST attach a voided check, savings account deposit slip or a
letter from your bank on bank letterhead with your routing and account number. No handwritten infomation or temporary
checks are accepted.
• Staple or Tape your voided check or savings account deposit slip to this form.
• Your name MUST be pre-printed on the voided check or savings account deposit slip.
• We CANNOT deposit your funds into an account that is not located within the United States or its Territories (i.e. Puerto Rico;
U.S. Virgin Islands; American Samoa).
• Mail or Fax this completed form to:
Conduent for OESC Direct Deposit
Dept. SGS
Mustang Rd.
Yukon, OK
Fax Number:
REQUIRED INFORMATION FOR DIRECT DEPOSIT:
THIS FORM WILL BE REJECTED IF YOUR ACCOUNT INFORMATION IS NOT INCLUDED
Enrollee Information
First Name:_________________________ MI_____ Last Name_________________________
Social Security Number (SSN) ____ ____ ____- ____ ____ - ____ ____ ____ ___
Contact Telephone Number (
)________________________________
Account where I want my benefits deposited
Bank or Financial Institution ________________________________________________________
Bank Address ______________________________________________________________________
______________________________________________________________________
Account Type (select one): ____ Checking
____ Savings
Do you intend to deposit funds into an account outside of the United States: ____ Yes ____ No
If Yes, please identify the Bank Country: ________________________________ (Note: We cannot send
funds to countries outside the U.S. or its Territories)
Bank Routing/Transit Number: ____ ____ ____ ____ ____ ____ ____ ____ ____
Account Number
(up to
digits): ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____
You can find your bank information on your checks as shown below:
:
:
123456789
12 34567890
101
Routing/Transit Number
Account Number
I certify that I am eligible to receive payments from the Oklahoma Employment Security Commission (OESC). I authorize
the OESC to send my payments to the nancial institution named above to be deposited in the account indicated above.
This authorization will remain in force until Conduent receives noti cation asking for termination. Conduent shall have a
reasonable time to process the termination.
Signature: ______________________________________ Date: ________________________
Oklahoma Employment Security Commission Direct Deposit Enrollment Form
YOU ARE CURRENTLY ENROLLED IN THE OKLAHOMA DEBIT MASTERCARD
CARD PROGRAM
®
If you would like to sign up for Direct Deposit, you must complete this form and return it to the address
below: Direct Deposit may add
hours for receipt of funds.
• To have your funds directly deposited in your bank account, you MUST attach a voided check, savings account deposit slip or a
letter from your bank on bank letterhead with your routing and account number. No handwritten infomation or temporary
checks are accepted.
• Staple or Tape your voided check or savings account deposit slip to this form.
• Your name MUST be pre-printed on the voided check or savings account deposit slip.
• We CANNOT deposit your funds into an account that is not located within the United States or its Territories (i.e. Puerto Rico;
U.S. Virgin Islands; American Samoa).
• Mail or Fax this completed form to:
Conduent for OESC Direct Deposit
Dept. SGS
Mustang Rd.
Yukon, OK
Fax Number:
REQUIRED INFORMATION FOR DIRECT DEPOSIT:
THIS FORM WILL BE REJECTED IF YOUR ACCOUNT INFORMATION IS NOT INCLUDED
Enrollee Information
First Name:_________________________ MI_____ Last Name_________________________
Social Security Number (SSN) ____ ____ ____- ____ ____ - ____ ____ ____ ___
Contact Telephone Number (
)________________________________
Account where I want my benefits deposited
Bank or Financial Institution ________________________________________________________
Bank Address ______________________________________________________________________
______________________________________________________________________
Account Type (select one): ____ Checking
____ Savings
Do you intend to deposit funds into an account outside of the United States: ____ Yes ____ No
If Yes, please identify the Bank Country: ________________________________ (Note: We cannot send
funds to countries outside the U.S. or its Territories)
Bank Routing/Transit Number: ____ ____ ____ ____ ____ ____ ____ ____ ____
Account Number
(up to
digits): ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____
You can find your bank information on your checks as shown below:
:
:
123456789
12 34567890
101
Routing/Transit Number
Account Number
I certify that I am eligible to receive payments from the Oklahoma Employment Security Commission (OESC). I authorize
the OESC to send my payments to the nancial institution named above to be deposited in the account indicated above.
This authorization will remain in force until Conduent receives noti cation asking for termination. Conduent shall have a
reasonable time to process the termination.
Signature: ______________________________________ Date: ________________________