USA Dealer Power Up Binder - Flipbook - Page 42
DEALER DIRECT DEPOSIT AUTHORIZATION FORM
Complete and return form along with a Voided Check and W-9 Form to 877.303.4653 or
dealersetup@sheffieldfinancial.com
If your bank account does not have checks or you have a new account with starter checks, please have your bank
representative provide your dealership name, address, routing number, and full account number on bank letterhead along
with their contact information. STARTER CHECKS ARE NOT ACCEPTED.
Please select from the following: (must check one)
❑ New Sheffield Dealer/Seeking Reactivation ❑ Dealership has changed ownership ❑ New bank account
Dealership Name and DBA if applicable: ________________________________________________________
Owner or Owner Principal of Dealership: ________________________________________________________
Sheffield Dealer Number: __________________ Federal Tax ID Number (TIN#): ______________________
Dealership Address: _______________________________________________________________________________
Dealer Contact: _________________________________ Phone: ____________________________________
Direct Deposit Confirmation Email address: ______________________________________________________
Manufacturer brands registering to finance with Sheffield (must be authorized dealer):____________________
__________________________________________________________________________________________
Additional Store Location(s) and Address(es) to be applied to this bank account: _________________________
__________________________________________________________________________________________
Bank Transit Routing Number: __________________ Bank Account Number: _________________________
❑ Checking Account ❑ Savings Account Bank Name:
___________________________________________
Bank Address and Phone Number: _____________________________________________________________
Customer agrees to initiate credit and debit Entries pursuant to and in accordance with the terms and conditions of the Sheffield Dealer Standards,
and to comply and be bound at all time with the laws of the states where Customer does business, the laws of the United States of America, including
but not limited to promulgations of the Office of Foreign Asset Control (“OFAC”), and the rules of the National Automated Clearing House
Association (the "Rules"). Authorized Signer must provide physical signature to document. Electronic Signatures are not acceptable.
Signature__________________________________________________________ Date ___________________
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PLEASE ATTACH VOIDED CHECK HERE
Please allow 24-48 hours for set up. If all information on the enrollment form is not provided, there may be a delay in processing.
Please call 800.438.8892 and request the Implementation Department should you have any questions regarding this form.
