Direct Deposit Form

[{"type":"header","subtype":"h4","label":"Step 1","className":"d-block"},{"type":"radio-group","required":true,"label":"I hereby authorize the Housing Authority of Florence to initiate credit entries and if necessary adjustments for any credit entries in error to my account.","name":"authorization-to-initiate-credit-entries","className":"d-block","values":[{"label":" Add Direct Deposit","value":"add direct deposit"},{"label":" Change Direct Deposit Information","value":"change direct deposit info"},{"label":" Cancel Direct Deposit","value":"cancel direct deposit"}]},{"type":"header","subtype":"h4","label":"Step 2","className":"d-block"},{"type":"radio-group","required":true,"label":"Checking or Savings","inline":true,"name":"checking-or-savings","className":"d-block","values":[{"label":" Checking","value":"checking"},{"label":" Savings","value":"savings"}]},{"type":"header","subtype":"h4","label":"Step 3","className":"d-block"},{"type":"file","required":true,"label":"Please attach a VOIDED check from your checking account. This will be used to verify routing and account numbers. Deposit slips are not acceptable. You may upload up to 20 files (35 Mb max). Files can be PDF, JPG, JPEG format.","name":"file-uploader-for-voided-check","subtype":"file","multiple":true,"className":"d-block"},{"type":"text","required":true,"label":"Routing Number","name":"routing-number","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Account Number","name":"account-number","className":"col-md-6","subtype":"text"},{"type":"header","subtype":"h4","label":"Step 4","className":"d-block"},{"type":"radio-group","required":true,"label":"Corporation or Individual","inline":true,"name":"Corporation-or-Individual","className":"d-block","values":[{"label":" Corporation (Legally Incorporated) ","value":"corporation"},{"label":" Individual","value":"individual"}]},{"type":"header","subtype":"h4","label":"Step 5: Read and Sign","className":"d-block"},{"type":"paragraph","subtype":"p","label":"I understand that any funds paid through direct deposit should be credited to my account on the first working day of the month.","className":"d-block"},{"type":"text","required":true,"label":"Signature (by typing your name you are signing this form)","name":"signature","className":"col-md-6","subtype":"text"},{"type":"date","required":true,"label":"Signature Date","name":"signature-date","className":"col-md-6"},{"type":"text","subtype":"email","required":true,"label":"Email","name":"email","className":"col-md-6"},{"type":"text","subtype":"email","required":true,"label":"Email Confirmation","name":"email-confirmed","className":"col-md-6"},{"type":"text","subtype":"tel","label":"Phone Number","name":"Phone-Number","className":"col-md-6"},{"type":"text","label":"If a Landlord, please include the Tenant's Name (list at least one tenant)","name":"tenant-names-if-landlord-completing-form","className":"col-md-6","subtype":"text"}]