Transcription of Direct Deposit Sign-Up Form Attachment
1 FS form 5396-1 Department of the Treasury | Bureau of the Fiscal Service OMB No. 1530-0050 FS form 5396-1 (Revised June 2020) Direct Deposit Sign-Up form Attachment Attached to and made a part of FS form : _____ sign in ink. sign Here: _____ _____ _____ (Print Name) (Social Security Number) Home Address _____ _____ (Number and Street or Rural Route) (Daytime Telephone Number) _____ _____ (City) (State) (ZIP Code) (E-mail Address) sign Here: _____ _____ _____ (Print Name) (Social Security Number) Home Address _____ _____ (Number and Street or Rural Route) (Daytime Telephone Number) _____ _____ (City) (State) (ZIP Code) (E-mail Address) sign Here: _____ _____ _____ (Print Name) (Social Security Number) Home Address _____ _____ (Number and Street or Rural Route) (Daytime Telephone Number) _____ _____ (City) (State) (ZIP Code) (E-mail Address) sign Here.
2 _____ _____ _____ (Print Name) (Social Security Number) Home Address _____ _____ (Number and Street or Rural Route) (Daytime Telephone Number) _____ _____ (City) (State) (ZIP Code) (E-mail Address)
