Direct Deposit Cancellation Form

Today’s Date(Required)

Please cancel my Direct Deposit effective immediately.

Completed by:

Tribal Member Name(Required)

Tribal ID #(Required)

Tribal Member Signature(Required)

Last 4 of Social Security Number (for verification purposes)(Required)

Phone Number(Required)

I would like my LIVE check to be

Held at the Tribal Admin Office for me to pick up

Sent to me at this address

Address

Street Address Address Line 2 City State ZIP Code

Comments

This field is for validation purposes and should be left unchanged.

Cahuilla Band of Indians
52701 US Hwy 371
Anza, CA 92539

Phone | (951) 763-5549
Fax | (951) 763-2808