Tenants and Residents Direct Deposit Authorization

Phone: 954-989-4691
Fax: 954-961-8010
HollywoodHousingAuthority.com

If you prefer to print this form, please complete and return to: 
Hollywood Housing Authority
7300 N. Davie Road Extension
Hollywood, FL 33024

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

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.