"Application / Change Form - Direct Deposit Service" - New Brunswick, Canada

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Regional Development Corporation
Regional Development Corporation use only
Application / Change Form
Direct Deposit Service
Supplier / Employee number
Please send the completed form to the Regional Development Corporation, P.O. Box 6000, Fredericton, NB E3B 5H1, or
email to
RDC-SDR@gnb.ca
or fax a copy to (506) 453-7988. For questions, contact us at (506) 453-2277.
All fields must be completed.
***IMPORTANT***
Name /
Please attach a “Void” cheque or cheque specimen to this form
Operating Name
in order for us to verify your banking information.
I/We hereby authorize the Regional Development Corporation
Legal or
(RDC) to credit this account with any payments due from RDC
Corporate Name
until appropriate authority is received to indicate otherwise.
Address
The form must be signed. Please note, for municipalities or non-
profit organizations two authorized signatures are required.
Contact Name
Phone Number
_____________________________
__________________________
Signature
Signature
Email Address
Definitions:
______________________________
___________________________
Name / Operating Name: Record your individual/Agency/Company/
Title
Title
Business operating name (the name on your invoices or cheques).
Legal or Corporate Name: Record your Agency/Company/Business
legal or Corporate name if different than above.
______________________________
__________________________
Address: Record your full mailing address.
Date
Date
Email Address: Email address where remittance notices will be sent.
Regional Development Corporation use only
Set up
Date
Review
Date
Regional Development Corporation
Regional Development Corporation use only
Application / Change Form
Direct Deposit Service
Supplier / Employee number
Please send the completed form to the Regional Development Corporation, P.O. Box 6000, Fredericton, NB E3B 5H1, or
email to
RDC-SDR@gnb.ca
or fax a copy to (506) 453-7988. For questions, contact us at (506) 453-2277.
All fields must be completed.
***IMPORTANT***
Name /
Please attach a “Void” cheque or cheque specimen to this form
Operating Name
in order for us to verify your banking information.
I/We hereby authorize the Regional Development Corporation
Legal or
(RDC) to credit this account with any payments due from RDC
Corporate Name
until appropriate authority is received to indicate otherwise.
Address
The form must be signed. Please note, for municipalities or non-
profit organizations two authorized signatures are required.
Contact Name
Phone Number
_____________________________
__________________________
Signature
Signature
Email Address
Definitions:
______________________________
___________________________
Name / Operating Name: Record your individual/Agency/Company/
Title
Title
Business operating name (the name on your invoices or cheques).
Legal or Corporate Name: Record your Agency/Company/Business
legal or Corporate name if different than above.
______________________________
__________________________
Address: Record your full mailing address.
Date
Date
Email Address: Email address where remittance notices will be sent.
Regional Development Corporation use only
Set up
Date
Review
Date