Tenants and Residents Direct Deposit Authorization

Rocky Mount Housing Logo.

1065 Pinehurst Drive | PO Box 4717 | Rocky Mount, NC 27803
Phone: 252.977.3141
Fax: 252.977.2587
Emergency After-Hours: 252.977.6223
Office Hours: Monday - Friday | 8:30 am - 5:00 pm

Equal housing, handicap accessible, and ADA logos.

If you prefer to print this form, please complete and return to:
Rocky Mount Housing Authority
1065 Pinehurst Drive
PO Box 4717
Rocky Mount, NC 27803

If you wish to complete this form online, please fill out and submit below.

Fields marked with * must be filled out or form will not submit.

Part 1: Transaction Type

Check the Appropriate box(es).

NOTE: The payee must review Part 2 and complete Part 3 for all Transaction Types

NEW SETUP - Select if payee is not currently on direct deposit.

The payee or financial institution representative must complete Part 4.

CANCELLATION - Select if payee wants to stop direct deposit.

Do not complete Part 4.

CHANGE FINANCIAL INSTITUTION

The payee or NEW financial institution representative must complete Part 4.

CHANGE ACCOUNT NUMBER

The payee or financial institution representative must complete Part 4.

CHANGE ACCOUNT TYPE

The payee or financial institution representative must complete Part 4.