Temporary Disability Insurance
Direct Deposit Authorization Form

The following form authorizes Temporary Disability Insurance to directly deposit your benefit check into a savings or checking account. It is in pdf format. You must have Adobe Reader to view it.

Please print out the form, fill it in, attach check marked "void" or bank documentation
of routing and account numbers and mail everything to;

Temporary Disability Insurance
P.O. Box 20100
Cranston, RI 02920

Direct Deposit Authorization Form

Use this check to find your bank's routing number and your account number.
THIS IS NOT A REAL CHECK!