Bank Tax Refund Direct Deposit Authorization Form
Use this form to provide the information needed to deposit your tax refund directly into your bank account.
Taxpayer Information
Legal Name
*
First Name
Middle Name
Last Name
Address Line 1
*
Address Line 2
City
*
State/Province
*
Postal Code
*
Country
*
Tax Filing Year / Refund Year
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Direct Deposit Account Setup
Deposit Setup Type
*
New deposit setup
Update existing deposit instructions
Bank Name
*
Account Type
*
Checking
Savings
Account Holder Name
*
First Name
Middle Name
Last Name
Account Identifier (last 4 digits or nickname)
Refund Deposit Instructions
Tax Agency or Refund Source Name
Refund Year or Tax Period
*
Please Select
2024
2025
2026
Other
Deposit Type
*
Full refund
Partial refund
Split Deposit Instructions
Authorization and Confirmation
Authorization Confirmation
*
I authorize the listed refund to be deposited to the bank details provided and confirm the information is accurate.
Signature
*
Submit Authorization
Submit Authorization
Should be Empty: