Tax Refund or PFD Direct Deposit
UA College Savings Plan

Mail to:
UA College Savings Plan
P.O. Box 17300
Baltimore, MD 21297-1300

Express delivery only:
UA College Savings Plan
Mail Code: OM-17300
4515 Painters Mill Road
Owings Mills, MD 21117-4903

Use this form to have your income tax refund or Permanent Fund Dividend (PFD) sent electronically to your UA College Savings Plan account(s). This form must be on file prior to the transmittal of the funds or your deposit may not be applied correctly. Do not send this form to the Internal Revenue Service ("IRS") or Alaska PFD office.

The allocation you request below will apply to all tax refunds or dividend sent to the UA College Savings Plan. Retain the direct deposit account number below and provide it to the IRS or Alaska PFD office each year. This number is unique and assigned specifically to your direct deposit. To change the allocation of your direct deposit, call 800-478-0003 and provide your direct deposit account number.

Tax Refund: Using the information below, complete the refund section of your IRS Form 1040 and/or your state income tax return. For state refunds, your state must accept a 17-digit account number.

Permanent Fund Dividend: Using the information below, complete the direct deposit section of your PFD application.

  • Routing Number: 011000028
  • Type of Account: Select Checking
  • Account Number: 99020554000153976, NOT your UA College Savings Plan Account Number

Complete and return this Direct Deposit form to the address above. Your requested allocations must total 100% and be directed to existing accounts.

Name of Account Holder or Custodian Social Security Number of Account
Holder or Custodian
Contact Phone Number   Alternate Phone Number
 
Portfolio Name UA College Savings Plan
Account Number
Beneficiary Name Percentage of Refund
(Entries must total 100%)
 %
 %
 %
    Total:  100%
Signature of Account Holder or Custodian Date


201901-707804