ContractVendor Authorization Agreement for Ach Payment • February 24th, 2021
Contract Type FiledFebruary 24th, 2021VENDOR AUTHORIZATION AGREEMENT FOR ACH PAYMENTDirections• Type or print the information requested in Sections 1 and 2. Then sign, date, and return the form via email.• Any account changes must be reported to Houston County within 14 days prior to actual change. A payee must keep Houston County informed of any address changes in order to receive important information and to remain qualified for payments.Section 1 - Entity to Receive Direct Deposit Type of Transaction: Add Change Delete Name of Company OR Individual County Telephone Street Address City State Zip Contact Person Email 9-digit Federal Tax ID Section 2 - Financial Institution Authorized to Conduct TransactionFinancial Institution County Telephone Street Address City State Zip Type of Account Checking Savings9-digit Transit Routing/ABA Number Account Number at Above InstitutionWhereby we authorize Houston county to initiate credit entries to our account in the financial institution our account identified above and also debit