Landlord Direct Deposit - Columbia County Housing & Redevelopment Authority

If you are not comfortable filling out the online Direct Deposit form, please download and print a copy. You can drop off the form and a voided check to our office at 160 W 6th Street Suite 101, Bloomsburg PA 17815 between 8:30 AM- 3:30 PM. If you are unable to print the form a copy can be provided at the office.

Company

This field is for validation purposes and should be left unchanged.

Directions

1.) Attach an original voided check for the checking account into which you would like the Housing Authority to deposit the funds; you may write “VOID” across the front of the check and blacken the signature portion of the check. If you are having your funds deposited into a savings account you will need to obtain the correct “Routing Number” from your bank, along with the savings account number and submit it with the enclosed authorization form.
2.) Please allow 60-90 days to process.

Landlord Name(Required)

First Last

Landlord Phone(Required)

Landlord Mailing Address(Required)

Street Address City State ZIP Code

ID Number Type(Required)

Please select what ID type you will provide.

Social Security Number

Federal ID Number

SS Number(Required)

Enter your Social Security number.

Federal ID(Required)

Enter your federal ID number.

Email(Required)

Voided Check(Required)

Please attach an image of a voided check. WE CANNOT PROCESS YOUR DIRECT DEPOSIT WITHOUT A VOIDED CHECK ATTACHED. you may write “VOID” across the front of the check and blacken the signature portion of the check.

Max. file size: 1 GB.

Banking Info

Direct Deposit Type(Required)

Checking

Savings

Credit Union

Other

Bank Name(Required)

Routing Number(Required)

Account Number(Required)

Additional / Consent Submission

Additional Comments

Consent(Required)

I hereby authorize and request the Columbia County Housing Authority, hereinafter called the CCHA, to make payment of any amounts owed to me by initiating credit entries to my account indicated below in the bank named below, hereinafter called the BANK, and I authorize and request the BANK to accept any deposits initiated by the CCHA to such account and to credit the same to such account without responsibility for the correctness thereof. In the event of an overpayment in error, I hereby authorize the CCHA to initiate correcting entries to my account in the amount of such error.

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I hereby release, waive, discharge and covenant not to sue Columbia County Housing & Redevelopment Authority and any of their agents, web developers or employees (hereinafter referred to as the “RELEASEES”) for any liability, claim and/or cause of action arising out of or related to any security breach, identity theft, data theft, loss of data, or irreparable damage (including but not limited to monetary and reputation) that occurs as a result of but not limited to the use of this website, this web form, submitted data or any related website software / plugins.

I further understand and consent that I am sharing/submitting my information to Columbia County Housing & Redevelopment Authority and that my data will be stored on the web servers they use. I agree that my typed data in form fields that are designated to be encrypted will be encrypted in transmission and at rest in the database, but Uploaded files attached to the submission will be encrypted in transmission and may not be encrypted at rest.

I agree to indemnify and hold harmless the RELEASEES whether
data loss is caused by negligence, the negligence of the RELEASEES or the
negligence of a third party. I further agree that this Release and
Waiver of Liability shall bind me. I hereby further agrees that this Release and Waiver of Liability shall be construed in accordance with the laws of the State of Pennsylvania, United States of America. By agreeing to this Release and Waiver of Liability, I state that I have read and understand the conditions set forth in this Release and that I agree to all conditions set forth herein, and that I agree to this voluntarily.

I agree to this policy.

Signature(Required)

Sign to agree and confirm consent to our submission policy.

COlumbia County, PA

Directions

Banking Info

Additional / Consent Submission

contact us by phone, e-mail or
submit a question.

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