2020_ACH_FORM_(2).pdf

PDF 54 KB Posted

Attached to
FIELD EQUIPMENT MAINTENANCE SERVICES- IFB
Solicitation number
25-S-006
Issued by
District of Columbia

About this file

This document is an Authorization Agreement for Automatic Deposits (ACH Credits) form from the Washington Convention and Sports Authority (WCSA), also known as Events DC, located in the District of Columbia. The form is designed to enable electronic financial transactions, allowing the organization to initiate credit and debit entries to a specified bank account. This form appears to be associated with a broader procurement process for Field Equipment Maintenance Services, which is designated exclusively for District of Columbia Department of Small, Local, and Business Development (DSLBD) certified business enterprises.

The form requires detailed banking information, including the company name, tax ID, depository bank details, account type, transit/ABA number, and account number. The authorization remains in effect until written notification of termination is provided, giving the company and depository reasonable time to process the change. The document includes fields for the authorized representative's name, title, contact information, and signature, with a specific instruction to attach a voided check to verify the banking details. The form is part of the administrative documentation for a local government contract opportunity focused on field equipment maintenance services within the District of Columbia.

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Text version

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS (ACH CREDITS)

COMPANY NAME: _____________________________________

EIN or Tax ID of the Business: ________________________________________

I (we) hereby authorize Washington Convention and Sports Authority (WCSA), hereinafter called COMPANY, to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries in error to my (our) Checking Savings account (select one) indicated below and the depository named below, hereinafter called DEPOSITORY, to credit and/or debit the same to such account.

DEPOSITORY

NAME BRANCH

CITY STATE ZIP

TRANSIT/ABA NO. ACCOUNT NO.

This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

NAME: __ TITLE: _______________________

Email for ACH Notification: ______________________ cc: ___________________________

PHONE #: __________________________________ DATE: ________________________

SIGNATURE:

*** ATTACH A VOIDED CHECK ***

File details come from the government source that posted it. Updated .