DIRECT DEPOSIT FORM

As a property owner receiving Housing Assistance, Payments (HAP) or a participant receiving a utility reimbursement check, you are required to enroll in HAC'S direct deposit program in which payments are deposited electronically into your bank account. HAC offers direct deposit of monthly Housing Assistance Payments (HAP) and utility reimbursement checks as a way to increase efficiency and improve service to our participants. Details of the deposit will be emailed to the email address you provide.

In order to begin, you must complete this authorization form and return it to the office along with a voided check or a letter from your bank verifying the routing number and account number. If you do not have a checking or savings account you may use a reloadable prepaid debit card (examples are Chime, Cash App, Green Dot prepaid card, Walmart Money Card, Net Spend, etc.) as long as the card has a routing number and account number that allows direct deposits. The authorization will remain in full force and effect until the HAC has received written notice from you of it's termination. You must notify us by completing another authorization form if at any time the account closes or you wish to change accounts.

If you have any questions, please contact the front desk at ext. 100 or Shaquita at 843-248-7327 ext. 103.

[{"type":"header","subtype":"h2","label":"Consent To Begin Direct Deposit","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div><span style=\"font-family: var(--bs-body-font-family); text-align: var(--bs-body-text-align);\">I hereby authorize the Housing Authority of Conway (HAC) to deposit my utility reimbursement payment to my account at the financial institution named below. In the event that the HOUSING AUTHORITY OF CONWAY deposits funds incorrectly into my account, I authorize the HAC to debit my account for an amount not to exceed the original amount of the incorrect credit..</span><br></div>","className":"d-block"},{"type":"text","required":true,"label":"Payee Name","name":"Payee-Name","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"SSN","name":"SSN","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Telephone Number","name":"telephone-number","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Email address","name":"email-address","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Name of Bank","name":"Name-of-Bank","className":"d-block","subtype":"text"},{"type":"checkbox-group","required":true,"label":"Type of Account","name":"Type-of-Account","className":"d-block","values":[{"label":"Checking Account","value":"checking-account"},{"label":"Savings Account","value":"savings-account"}]},{"type":"text","required":true,"label":"Routing Number","name":"routing-number","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Account Number","name":"account-number","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div><span style=\"font-family: var(--bs-body-font-family); text-align: var(--bs-body-text-align);\">The HAC may also terminate the direct deposit if it is determined that eligibility is no longer met, and /or in order to recover any overpayments made. Additionally, if any action taken by me results in non-acceptance of a direct deposit by the designated financial institution, I understand that the HAC assumes no responsibility for processing a supplemental payment until the amount of the non-acceptance deposit is returned to the HAC by the financial institution. The payee certifies compliance with the Housing Assistance Payment Contract by accepting direct deposit. </span><br></div>","className":"d-block"},{"type":"text","required":true,"label":"Signature","placeholder":"Disclaimer: By typing your name, you are signing this document","name":"Signature","className":"col-md-6","subtype":"text"},{"type":"date","label":"Date Field","name":"date-1727870505744","className":"d-block"}]