As you can see, the bank letter example above has all of the required components (date, name of bank, account name, account number, routing number). A separate copy of the Electronic Fund Transfer Authorization form is required for each bank account.Instructions for completing this form are on the back. Please print clearly and use black ink. 1. Fill out both copies of the attached Exemption Form (JGM401) in this packet. To have funds placed in different bank accounts, you must complete a separate Direct Deposit Agreement for each plan. Is this a joint account? Complete the caption information on the Notice of Levied Funds (JGM602) and the. Fill out the authorization form and return it to the. Child Care Assistance Program agency listed on the following page.