ACH Authorization Form

Please complete entirely

Name

Address

City

State

Zip code

What program is this for?

City of Detroit- Detroit Housing Services ProgramOther Program

Name of Bank

Account #

Reconfirm Account #

Routing # (9 digits)

Please confirm this number with your bank as some banks use different routing numbers for ACHs

Reconfirm Routing # (9 digits)

Please confirm this number with your bank as some banks use different routing numbers for ACHs

Type of Account

CheckingSavings

Please upload an image of your check or deposit slip

By submitting this form, I am hereby authorizing Wayne Metro to directly deposit funds to the account listed above.