ContractVendor Authorization Agreement for Ach Payment • February 24th, 2021
VENDOR 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 at the financial institution identified above and also debit entries, if
ContractVendor Authorization Agreement for Ach Payment • February 24th, 2021
VENDOR 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
ContractVendor Authorization Agreement for Ach Payment • February 24th, 2021
VENDOR AUTHORIZATION AGREEMENT FOR ACH PAYMENTDirections• Type or print the information requested in Sections 1 and 2. Then sign, date, and return the form with your Vendor package.• Any account changes must be reported to DCA within ten (10) days prior to actual change. A payee must keep DCA informed of any address changes in order to receive important information about benefits and to remain qualified for payments. Please refer to the application instructions, if applicable. 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 Institution Whereby we authorize DCA to initiate credit entries to our account in th
ContractVendor Authorization Agreement for Ach Payment • February 24th, 2021
VENDOR AUTHORIZATION AGREEMENT FOR ACH PAYMENTDirections• Type or print the information requested in Sections 1 and 2. Then sign, date, and return the form with your Vendor package.• Any account changes must be reported to DCA within ten (10) days prior to actual change. A payee must keep DCA informed of any address changes in order to receive important information about benefits and to remain qualified for payments. Please refer to the application instructions, if applicable. 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 Institution Whereby we authorize DCA to initiate credit entries to our account in th
