Electronic Funds Transfer (EFT) Enrollment Form

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File: EFTA01265314_p4_i0.png dataset_10
Summary:

The image is a scanned EFT Enrollment Form for Citibank, N.A., with some sections redacted. The document is marked as confidential and contains financial information.

Content Type:
Image
Document Type:
image
Date:
N/A
Model Used:
gemini-2.0-flash-001
Image Classification
Category:
document_scan
Subcategory:
form
Scene & Environment

Setting: indoor

Location Type: office

Identified Location: Unknown

Time: unclear

Atmosphere: formal

Document Extraction

Type: form

Key Points:

  • EFT Enrollment Form
  • Payee/Company Information
  • Financial Institution Information
  • Citibank, N.A.
  • Cathrine R. Reinecke

Full Transcription:

ELECTRONIC FUNDS TRANSFER (EFT)
PAYEE/COMPANY/VENDOR
EFT ENROLLMENT FORM

USA DISTRICT:
ADORESS 1:
ADDRESS 21
CITY, STATE ZIP
CONTACT PERSON:
PHONE NUMBER:

PAYEE/COMPANYAND
ORMATION
NAME:
Citibank, N.A.
ADORESS 1:
701 E. 60th St., N.; MC1251
ADDRESS 21
CITY, STATE ZIP
Sloux Falls, SD 57117
E-MAIL ADDRESS:
TAXPAYER ID #:
13-5266470
CONTACT PERSON:
Cathrine R. Reinecke
FINANCIAL INSTITUTION INFORMATION
BANK NAME:
Citibank NA
BANK ADDRESS:
701 P. 60th St., N., Sioux Falls, 557117
PHONE NUMBER:
NINE-DIGIT ABA ROUTING TRANSIT NUMBER: 021000089
DEPOSITOR ACCOUNT NUMBER: 30997235
ACCOUNT ABOVE IS A CHECKING ACCOUNT
ACCOUNT ABOVE IS A SAVINGS ACCOUNT
TYPE OF ACCOUNT: X

CONFIDENTIAL
Text in Image
ELECTRONIC FUNDS TRANSFER (EFT)
PAYEE/COMPANY/VENDOR
EFT ENROLLMENT FORM
USA DISTRICT:
ADORESS 1:
ADDRESS 21
CITY, STATE ZIP
CONTACT PERSON:
PHONE NUMBER:
PAYEE/COMPANY AND
ORMATION
NAME:
Citibank, N.A.
ADORESS 1:
701 E. 60th St., N.; MC1251
ADDRESS 21
CITY, STATE ZIP
Sloux Falls, SD 57117
E-MAIL ADDRESS:
TAXPAYER ID #:
13-5266470
CONTACT PERSON:
Cathrine R. Reinecke
FINANCIAL INSTITUTION INFORMATION
BANK NAME:
Citibank NA
BANK ADDRESS:
701 P. 60th St., N., Sioux Falls, 557117
PHONE NUMBER:
NINE-DIGIT ABA ROUTING TRANSIT NUMBER: 021000089
DEPOSITOR ACCOUNT NUMBER: 30997235
ACCOUNT ABOVE IS A CHECKING ACCOUNT
ACCOUNT ABOVE IS A SAVINGS ACCOUNT
TYPE OF ACCOUNT: X
SDNY GM 00004181
CONFIDENTIAL
EFTA_00118255

Significance: The document is an Electronic Funds Transfer (EFT) Enrollment Form, which is used to set up direct deposit payments. The 'CONFIDENTIAL' watermark indicates the sensitive nature of the document.

Full Description

The image shows a scanned document, specifically an Electronic Funds Transfer (EFT) Enrollment Form. The form is partially filled out, with some sections redacted (blacked out). The visible sections include the title of the form, fields for Payee/Company Information, and Financial Institution Information. The Payee/Company Name is listed as 'Citibank, N.A.' with an address in Sioux Falls, SD. The Taxpayer ID is '13-5266470', and the Contact Person is 'Cathrine R. Reinecke'. The Bank Name is 'Citibank NA' with an address also in Sioux Falls, SD. The Nine-Digit ABA Routing Transit Number is '021000089', and the Depositor Account Number is '30997235'. The 'Type of Account' is marked as a checking account. The document has a 'CONFIDENTIAL' watermark at the bottom and reference numbers 'SDNY_GM_00004181' and 'EFTA_00118255'. The image quality is medium, with some blurriness. The redactions obscure portions of the form, making it impossible to determine the full context without the complete document.

Sensitivity: MODERATE

Categories: financial_exposure, identity_exposure

The document contains financial and personal information, including bank account details and taxpayer ID, which could be misused if exposed.

People
Cathrine R. Reinecke
Organizations
Citibank, N.A. Citibank NA
Locations
Sioux Falls, SD 57117
Themes
Financial transactions/money flow Legal matters/litigation
Raw Analysis