AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFERAuthorization Agreement for Electronic Funds Transfer • May 29th, 2023
During the1995 Regular Legislative Session, Act 954 was adopted requiring all Distributors and Suppliers to remit Motor Fuel Taxes to the State of Arkansas by Electronic Funds Transfer (EFT).
Authorization AgreementAuthorization Agreement for Electronic Funds Transfer • May 30th, 2020
Authorization Agreement for Electronic Funds Transfer of Arkansas Corporation Estimated Income TaxAuthorization Agreement for Electronic Funds Transfer • August 20th, 2021
DOR USE ONLYAuthorization Agreement for Electronic Funds Transfer • December 15th, 2003
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFERAuthorization Agreement for Electronic Funds Transfer • September 4th, 2012
THE PRINCE GEORGE'S COUNTY GOVERNMENT OFFICE OF HUMAN RESOURCES MANAGEMENT BENEFITS AND PENSIONS DIVISIONAuthorization Agreement for Electronic Funds Transfer • March 19th, 2014
Note: The account listed below must be held in your name. You are prohibited from assigning your benefit to any other person.
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFER (SCO EFT-1)Authorization Agreement for Electronic Funds Transfer • May 4th, 2017
Complete Section I Below: Please Check Appropriate Boxes New ACH RegistrationChange EFT Remittance Method Change Holder Contact Information HOLDER INFORMATION FEDERAL EMPLOYER ID# (FEIN): - NAME ADDRESS CITY STATE ZIP UNCLAIMED PROPERTY HOLDER TYPECODE PHONE ( _ _ _ ) _ _ _ - _ _ _ _ EXT CONTACT INFORMATION (for EFT Registration) NAME EMAIL PHONE ( _ _ _ ) _ _ _ - _ _ _ _ EXT FAX ( _ _ _ ) _ _ _ - _ _ _ _ Complete Section II, III or IV Below: SECTION II ACH DEBIT I have verified our company’s Financial Institution can originate an ACH Debit transaction in the required record field. SIGNATURE: TITLE DATE SECTION III ACH CREDIT I have verified our company’s Financial Institution can originate an ACH Credit transaction in the required record field. SIGNATURE: TITLE DATE SECTION IV INTERNATIONAL FUNDS TRANSFER SIGNATURE TITLE DATE
as it appears on your bank account)Authorization Agreement for Electronic Funds Transfer • November 13th, 2001
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFERAuthorization Agreement for Electronic Funds Transfer • April 4th, 2018
Authorization Agreement for Electronic Funds TransferAuthorization Agreement for Electronic Funds Transfer • November 14th, 2014
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFERAuthorization Agreement for Electronic Funds Transfer • March 29th, 2007
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFER (SCO EFT-1)Authorization Agreement for Electronic Funds Transfer • January 4th, 2007
Complete Section I Below: Please Check Appropriate Boxes New ACH RegistrationChange EFT Remittance Method Change Holder Contact Information HOLDER INFORMATION FEDERAL EMPLOYER ID# (FEIN): - NAME ADDRESS CITY STATE ZIP UNCLAIMED PROPERTY HOLDER TYPE CODE PHONE ( _ _ _ ) _ _ _ - _ _ _ _ EXT CONTACT INFORMATION (for EFT Registration) NAME EMAIL PHONE ( _ _ _ ) _ _ _ - _ _ _ _ EXT FAX ( _ _ _ ) _ _ _ - _ _ _ _ Complete Section II, III or IV Below: SECTION II ACH DEBIT I have verified our company’s Financial Institution can originate an ACH Debit transaction in the required record field. SIGNATURE: TITLE DATE SECTION III ACH CREDIT I have verified our company’s Financial Institution can originate an ACH Credit transaction in the required record field. SIGNATURE: TITLE DATE SECTION IV INTERNATIONAL FUNDS TRANSFER SIGNATURE TITLE DATE
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFER (ACH Distributions AND Deposits)Authorization Agreement for Electronic Funds Transfer • January 24th, 2018
OFFICE OF THE CITY TREASURERAuthorization Agreement for Electronic Funds Transfer • November 1st, 2002
AUTHORIZATION AGREEMENTAuthorization Agreement for Electronic Funds Transfer • April 2nd, 2018
NAME SERVICE ADDRESS ACCOUNT NUMBER (as shown on utility bill) DESCRIPTION OF DEBITOKALOOSA COUNTY WATER & SEWER UTILITY BILL NAME OF BANK BANK ROUTING TRANSIT/ABA NUMBER (9 digits) BANK ACCOUNT NUMBER (include leading zeros) See check illustration on next page ACCOUNT HOLDER NAME (as shown on bank account) CHECKING ATTACH A VOIDED CHECK SAVINGS ATTACH A VOIDED DEPOSIT SLIP SIGNATURE SIGNATURE (joint account) DATE PHONE NUMBER DATE PHONE NUMBER
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFER (SCO EFT-1)Authorization Agreement for Electronic Funds Transfer • March 4th, 2011
CITY STATE ZIP UNCLAIMED PROPERTY HOLDER TYPE CODE PHONE ( _ _ _ ) _ _ _ - _ _ _ _ EXT CONTACT INFORMATION - REPORT FILER NAME EMAIL PHONE ( _ _ _ ) _ _ _ - _ _ _ _ EXT FAX ( _ _ _ ) _ _ _ - _ _ _ _
Extend-A-Pay, Inc.Authorization Agreement for Electronic Funds Transfer • May 31st, 2021
Authorization Agreement for Electronic Funds Transfer of ArkansasAuthorization Agreement for Electronic Funds Transfer • January 15th, 2009
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFERAuthorization Agreement for Electronic Funds Transfer • October 24th, 2019
We hereby authorize the direct deposit of our Designation payment by United Way of the Capital Region in the account and financial institution indicated below. Such direct deposit will be made monthly/quarterly, unless we choose to terminate this agreement in writing to United Way of the Capital Region. Any such notification to United Way of the Capital Region shall become effective following receipt, after a reasonable opportunity to act on it.
DOR USE ONLYAuthorization Agreement for Electronic Funds Transfer • December 15th, 2003
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFERAuthorization Agreement for Electronic Funds Transfer • October 2nd, 2019
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFERAuthorization Agreement for Electronic Funds Transfer • December 18th, 2004
City, State, Zip City, State, Zip Phone number Fax number Phone number Fax number E-mail Address E-mail Address Taxes to be paid using EFT:Tax Type Code KY ID Number Business Name FEIN
BLACK HAWK COUNTY TREASURER 316 E. 5th St.Authorization Agreement for Electronic Funds Transfer • February 26th, 2015
The Black Hawk County Treasurer’s office will begin utilizing an ACH credit for redemption refunds. Funds will be credited directly to your account.
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFERAuthorization Agreement for Electronic Funds Transfer • July 26th, 2016
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFER (ACH Distributions AND Deposits)Authorization Agreement for Electronic Funds Transfer • April 13th, 2020
Authorization Agreement for Electronic Funds TransferAuthorization Agreement for Electronic Funds Transfer • February 1st, 2023
• To the best of my knowledge and belief, all statements and answers made on this form and all associated application forms are true.
Authorization Agreement for Electronic Funds TransferAuthorization Agreement for Electronic Funds Transfer • October 22nd, 2007 • Delaware
The Lawyer or Law Firm named above (hereinafter the “Law Firm”), which files asbestos personal injury claims with the Claims Resolution Management Corporation (“CRMC”), hereby authorizes the CRMC to deposit claim settlement payments to the account listed below. If monies to which the Law Firm is not entitled are erroneously deposited to that account, the Law Firm warrants that it will promptly inform the CRMC of the mistake and will direct its financial institution to return such funds to the CRMC. The Law Firm further authorizes the financial institution to credit and/or debit such transactions to its account. This authority will remain in effect until the Law Firm has cancelled it in writing.
Authorization agreement for electronic funds transferAuthorization Agreement for Electronic Funds Transfer • March 7th, 2018
Trustmark Life Insurance Company of New YorkAuthorization Agreement for Electronic Funds Transfer • April 8th, 2010
Mt. Crested Butte Water & Sanitation DistrictAuthorization Agreement for Electronic Funds Transfer • January 21st, 2009
Authorization Agreement for Electronic Funds TransferAuthorization Agreement for Electronic Funds Transfer • July 12th, 2018
Tuition plus fees may be paid via Electric Funds Transfer (EFT) in ten installments with the fees plus a double tuition installment paid on August 15th, and then 8 monthly tuition installments paid on the 15th of each month, September through April. Electronic funds transfer is available for any tuition payments that you authorize with your initials below.
Authorization Agreement for Electronic Funds TransferAuthorization Agreement for Electronic Funds Transfer • October 23rd, 2015
The Lawyer or Law Firm named above which files asbestos personal injury claims with the Claims Resolution Management Corporation (“CRMC”), hereby authorizes the CRMC to deposit claim settlement payments to the account listed below. If monies to which the Law Firm is not entitled are erroneously deposited to that account, the Law Firm warrants that it will promptly inform the CRMC of the mistake and will direct its financial institution to return such funds to the CRMC. The Law Firm further authorizes the financial institution to credit and/or debit such transactions to its account. This authority will remain in effect until the Law Firm has cancelled it in writing.
Authorization Agreement for Electronic Funds TransferAuthorization Agreement for Electronic Funds Transfer • April 3rd, 2020
Authorization Agreement for Electronic Funds TransferAuthorization Agreement for Electronic Funds Transfer • July 24th, 2019
Authorization Agreement for Electronic Funds TransferAuthorization Agreement for Electronic Funds Transfer • September 30th, 2010
