Direct Deposit Authorization

HASB - Housing Authority of South Bend Icon.

Housing Authority of South Bend
Phone: 574.235.9346 • Fax: 574.544.5165
501 Alonzo Watson Dr. • South Bend, IN 46601
Monday-Thursday 8:30 am-5:30 pm (Closed Fridays)

Equal Housing, Handicap Accessible, and Accessibility Icons.

If you prefer to print this form, please complete and return to:
Housing Authority of South Bend
501 Alonzo Watson Dr.
South Bend, IN 46601

If you wish to complete this form online, please fill out and submit below.

Fields marked with * must be completed or form will not submit.

Part 1: Transaction Type

Check the Appropriate box(es).

NOTE: The payee must review Part 2 and complete Part 3 for all Transaction Types

NEW SETUP - Select if payee is not currently on direct deposit.

The payee or financial institution representative must complete Part 4.

CANCELLATION - Select if payee wants to stop direct deposit.

Do not complete Part 4.

CHANGE FINANCIAL INSTITUTION

The payee or NEW financial institution representative must complete Part 4.

CHANGE ACCOUNT NUMBER

The payee or financial institution representative must complete Part 4.

CHANGE ACCOUNT TYPE

The payee or financial institution representative must complete Part 4.

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