Pay Rent Residents/Participants Landlords Maintenance Request Payment Standards Map

Landlords: Owner Direct Deposit Authorization Agreement

P.O. Box 900278
Homestead, FL 33090-0278
Office: 305.247.0639 | Fax: 305.248.3347
Hearing Impaired Assistance: TTY: 800.955.8771

Fields marked with * must be completed or the form will not submit.

[{"type":"text","required":true,"label":"Property Owner Name","name":"property-owner-name","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Tax ID or Social Security Number","name":"tax-id-or-social-security-number","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Property Owner Street Address","name":"property-owner-street-address","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"Property Owner City ","name":"property-owner-city","className":"col-lg-4","subtype":"text"},{"type":"select","required":true,"label":"Property Owner State","name":"State","className":"col-lg-4","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of 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State","name":"payee-State","className":"col-lg-4","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North 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Confirmation","name":"payee-email-confirmed","className":"col-lg-4"},{"type":"text","required":true,"label":"Payee Phone Number","name":"Payee-Phone-Number","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","required":true,"label":"Bank Name","name":"Bank-Name","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Bank City","name":"Bank-City","className":"col-lg-4","subtype":"text"},{"type":"select","required":true,"label":"Bank State","name":"Bank-State","className":"col-lg-4","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL","selected":true},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","required":true,"label":"Bank Routing Number","name":"bank-routing-number","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Checking Account Number","name":"checking-Account-Number","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"checkbox-group","required":true,"label":"Begin Direct Deposit","name":"Begin-Direct-Deposit","className":"d-block","values":[{"label":"I hereby authorize, Homestead Housing Authority (HHA), to deposit any amounts owed me by initializing credit entries to my designated account at the financial institution indicated above. Further, I authorize the Bank to accept and to credit any deposits provided by the HHA to my account. In the event the HHA erroneously deposits extra funds to my account, I further authorize the HHA to debit my account for the amount necessary to correct the error. This authorization is to remain in effect until the HHA and the Bank have received a written cancellation notice from me and have a reasonable opportunity to act on it.","value":"I hereby authorize, Homestead Housing Authority (HHA), to deposit any amounts owed me by initializing credit entries to my designated account at the financial institution indicated above. Further, I authorize the Bank to accept and to credit any deposits provided by the HHA to my account. In the event the HHA erroneously deposits extra funds to my account, I further authorize the HHA to debit my account for the amount necessary to correct the error. This authorization is to remain in effect until the HHA and the Bank have received a written cancellation notice from me and have a reasonable opportunity to act on it."}]},{"type":"checkbox-group","label":"Cancel Direct Deposit","name":"cancel-direct-deposit","className":"d-block","values":[{"label":"(Check this box only if updating bank account)","value":"(Check this box only if updating bank account)"}]},{"type":"date","label":"I hereby authorize Homestead Housing Authority to cancel direct deposit the current account on file as of","name":"Cancel-Direct-Deposit-Date","className":"d-block"},{"type":"text","label":"and to start depositing in my new bank account ending in XX-","name":"xx-","className":"d-block","subtype":"text"},{"type":"text","label":"Payee Initials","name":"payee-initials","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Owner Signature","placeholder":"Disclaimer: By typing your name, you are signing this document.","name":"Owner-Signature","className":"col-lg-4","subtype":"text"},{"type":"date","label":"Owner Signature Date","name":"Owner-Signature-Date","className":"col-lg-4"},{"type":"file","label":"Please attach an ORIGINAL VOIDED Check to this form","name":"voided-check-upload","subtype":"file","multiple":true,"className":"d-block"}]

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