Bank Verification Form
This section must be completed by the borrower
Â
Borrower's Name
First Name
Middle Name
Last Name
Reference Number
I authorize you to release the following information requested by ABC Financial, concerning my bank account with your bank.
Yes
No
This section must be completed by bank representative
Â
Financial Institution Name (Bank, C. Union, etc.)
Bank, Credit Union, etc.
Bank Adress
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Borrower's Routing Number
Account Number
Date of this account opened
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of the account
Checking
Saving
Prepaid account
Does this account accept ACH debits?
Yes
No
Has this account been pen for at least three months?
Yes
No
Does borrower have direct deposit into this Account?
Yes
No
Bank Representative's Signature
Date of this account opened
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Bank Representative's Name
First Name
Last Name
Bank Representative's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Send
Should be Empty: