Minnesota Direct Deposit Form 2
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RESET
For official use only:
Customer Name

Customer No.

PD F 5396 E
Department of the Treasury
Bureau of the Public Debt
(Revised August 2011)

OMB No. 1535-0128

Direct Deposit Sign-Up Form
Check one:

Interest payments

Redemption payment

Check this box if the address furnished below should not be used to update HH and H accounts.
Please Print:
Name (or names, if joint account)
Address

Telephone No. (Home)

(Work)

Social Security No.

OR Employer Identification No.
Enter the following information OR attach a voided check*:

Depositor’s Account No.

Type of Account

Bank Routing No.

Bank Phone No.

Checking

Savings

Financial Institution Name

*

If you want payments deposited at a credit union, DO NOT ATTACH A VOIDED CHECK. Ask the credit union to tell you the
correct routing number to use on this form.

For a joint account, only the person whose Taxpayer Identification Number is shown should sign the form.
Under penalty of perjury, I certify that:
1. The Taxpayer Identificati