The Indiana Housing and Community Development Authority (IHCDA) electronically

processes payments for the Covid-19 Rental Assistance Program if requested. Please
provide the following information so that IHCDA may initiate direct deposits to your
checking or savings account:

Date: ________________09/15/2022_________________________________________

Landlord Name: __________AMY BLAIR_______________________________________________

Contact Name and Phone #: ____AMY BLAIR__________(772) 228-1436___________________________________________

Bank Name: _______________STRIDE BANK__________________________________________

ABA Number: _________103100195________________________________________________

Account Number: _________248121965466________________________________________________

Type of Account: ____________CHECKING_____________________________________________

(checking or savings)

Print Name & Title ___AMY BLAIR__(LANDLORD)_________________________________________

Signature __________AMY BLAIR_______________________________________________

Check here if you would like to opt out of receiving direct deposit and instead receive payment by paper
check. NOTE: By opting to receive a paper check you are acknowledging that payment will be delayed.

Payable to: _______________________________________________________________________________

Address: ________________________________________

City: ___________________________________________

State: ______________
ZIP: ________________