2-ACH Enrollment Information - fillable.pdf

PDF 180 KB Posted

Attached to
Interior and Exterior Painting Services
Solicitation number
2026-10
Issued by
Dauphin County, Pennsylvania

About this file

This is an ACH (Automated Clearing House) Enrollment Information form related to the Harrisburg Housing Authority's Interior and Exterior Painting Services contract opportunity in Pennsylvania. The form serves as a fillable document for contractors to provide banking and payment information necessary for the HHA to process payments via ACH electronic transfer. The document is designed to streamline the contractor payment process by collecting essential banking details, including the contractor's financial institution information, account type, and authorization signatures. This enrollment form would be completed by contractors selected for award under the indefinite quantity, as-needed painting services contract, which covers both interior and exterior painting work on HHA-owned, HHA-affiliated, and HHA-managed properties throughout Harrisburg.

The ACH enrollment information captured in this form is a standard requirement for modern government contracting to facilitate timely and efficient electronic payment processing. By requiring contractors to complete this form, the HHA ensures compliance with electronic payment protocols while reducing administrative burden associated with manual payment processing. The information collected through this document directly supports the contract administration phase following the competitive bidding process, which includes a mandatory pre-bid site visit and conference that all authorized bidder representatives must attend and document by signing an attendance sheet.

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Text version

ACH Enrollment Information

Company Name: ____________________________________________________

Address:

FIN#

Duns#

Payment Remittance details should be directed to:

Contact

E-mail

Contact Phone #

Contact Fax#

Financial Institution Name: _____________________________________

Address:

Bank Account Name

Bank Contact Name

Bank Telephone Number

Bank Transit Routing Number

EFT Bank Account Number

Company Name:
FIN:
Duns:
Contact:
Email:
Contact Phone:
Contact Fax:
Financial Institution Name:
Bank Account Name:
Bank Contact Name:
Bank Telephone Number:
Bank Transit Routing Number:
EFT Bank Account Number:
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