Direct Deposit Form

Agents/Owners may authorize Berkeley Housing Authority to use direct deposit by completing this form with all required documents attached, including banking information. For checking accounts, please attach an original blank check (not a deposit slip) marked “VOID” when prompted. For savings accounts, please attach a savings withdrawal/ deposit slip that includes your name and account information.

Receive This Form by Mail or Pick-Up

Direct Deposit Form

"*" indicates required fields

Your Section 8 Tenants

Please manually list OR attach a document that lists ALL of your Section 8 Tenants below.

List all of your Section 8 tenants below:

Click the plus sign to add more rows.

Tenant Name

Tenant Address

Alternatively, upload a document that lists all of your Section 8 tenants:

Max. file size: 100 MB.

Direct Deposit Authorization

I (We) hereinafter called Owner or Agent, hereby authorize the Berkeley Housing Authority, hereinafter called BHA, to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries in error to my (our) account indicated below at the financial institution named below, hereinafter called Depository, to credit and/or debit the same to such account.

Legal Owner’s Name(s)*

As it appears on the Grant Deed:

Owner's Address*

Street Address Apt City State ZIP Code

Owner's Phone*

Owner's Email*

Enter Email Confirm Email

Agent's Name*

If different from owner, see Agent Policy below.

Agent's Address*

Street Address Apt City State ZIP Code

Agent's Phone*

Agent's Email*

Enter Email Confirm Email

Agent's Social Security Number/Tax I.D. #*

Agent Policy

If payments are to be made in the name of a person or entity acting as an agent of the legal owner BHA must have the following documents:

1. Agent/Management Agreement between the Owner and Agent.

2. BHA Payment and Ownership Declaration form authorizing payments to the Agent.

3. IRS W-9 form in the name of the Agent with the Agent SSN/taxpayer ID number.

*Note: If payments are made to an agent, the IRS 1099 statement will be mailed in the name of the Agent. If any of these documents have not been received, or if the SSN/TIN does not match, your direct deposit sign up will not be processed. Please download the necessary forms from BHA’s website at www.cityofberkeley.info/bha.

Upload Agent Policy Documents

Drop files here or

Max. file size: 100 MB.

Bank Information

Depository/Bank*

Account Type*

Checking

Saving

Branch Transit/ABA Routing Number*

Account Number*

Address*

Street Address City State ZIP Code

Documentation Instructions*

For checking accounts, please upload a copy or photo of a check (not a deposit slip) marked “VOID."

For savings account, please attach a savings withdrawal/ deposit slip that includes your name and account information.

For assistance, please call Grace Grish at (510) 981-5474 or email: BHAFinance@berkeleyca.gov

**Direct Deposit will be 4-6 weeks after we receive all necessary documentation**

Drop files here or

Max. file size: 100 MB.

This authority remains in full force and effect until BHA and the depository have received written notification from me (or either of us) of its termination in such time and in such manner as to afford BHA and depository a reasonable opportunity to act on it. I also agree to notify BHA of any changes to my bank account Information.

Signee's Name*

Signee's Email*

Enter Email Confirm Email

Legal Consent*

Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures

Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically.

You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below.

Scope of Consent
By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below.

Paper Copies
You are not required to sign documents electronically, or receive notices or disclosures electronically, and may request paper copies of documents or disclosures, if you prefer. You also have the ability to download and print any signed or unsigned documents sent to you through the electronic signature service. We may also email you a copy of all documents you sign using the electronic signature service. If you wish to receive paper copies instead of electronic documents you may close this web browser and request paper copies from the “sending party” by following the procedures outlined below. The “sending party” may apply a charge for additional expenses incurred by printing and mailing paper copies.

Withdrawal of Consent
You may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below.

Withdrawing your consent, requesting a paper copy, or updating your contact information
You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices.

“Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address.

“Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy .

“Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number.

The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.

I agree to the terms and conditions.

Signature*

Date*

CAPTCHA

Berkeley Housing Authority logo

Berkeley Housing Authority
1947 Center Street Fifth Floor, Berkeley, CA 94704
Telephone: (510) 981-5470 Fax: (510) 981-5480