Direct Deposit Form

Download Per Capita Form

Download Minor Form

Date

Is this for Per Capita or Minor Trust direct deposit?(Required)

Per Capita

Minor Trust

Name(Required)

First Middle Last

Last 4 SSN(Required)

Parent/Guardian Name(Required)

First Middle Last

Minor Name(Required)

First Middle Last

Maiden Name

If applicable

Tribal ID #(Required)

Phone(Required)

Financial Institution Name(Required)

Type of Account(Required)

Savings

Checking

Routing Number(Required)

Account Number(Required)

*Tribal Member Name must be on account. Voided Check or Statement from Bank Official Required.*

Direct Deposit Termination

I wish to terminate my direct deposit for the per capita payments.

If you would like to terminate your direct deposit payments, please check this box. Form must still be notarized.

I hereby authorize Tonkawa Tribe of Oklahoma to deposit any amounts owed to me, by initiating credit entries to my account at the financial institution (hereinafter "Bank") indicated on this form. Further, I authorize Bank to accept and to credit any entries indicated by Tonkawa Tribe to my account. In the event that Tonkawa Tribe deposits funds erroneously into my account, I authorize Tonkawa Tribe to debit my account for an amount not to exceed the original amount of the erroneous credit.

This authorization is to remain in full force and effect until the Tonkawa Tribe has received written notice from me of termination in such time and in such manner as to afford Tonkawa Tribe reasonable opportunity to act on it.

Signature

Date