Local EFT

Electronic Funds Transfer (Local)
Region
3 Letter Identifier*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Bank Name*
Bank Routing Number*
Checking/Savings Account Number*
Void Check Image*

Upload a File
Please upload a voided check from the account described above Cancelof
E-mail*
President or Treasurer Signature*
Should be Empty:

Electronic Funds Transfer (Local)