2020_ACH_FORM_(2).pdf
PDF 54 KB Posted
- Attached to
- IFB- DANCE FLOORS AND ASSOCIATED PRODUCTS
- Solicitation number
- 25-S-009
- 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, related to an Invitation for Bid (IFB) for Dance Floors and Associated Products. The form is designed to establish electronic payment instructions for a vendor participating in a procurement opportunity within the District of Columbia. The form allows a business to authorize WCSA to initiate direct credit and debit entries to a specified bank account for financial transactions associated with the contract.
The form requires the vendor to provide critical financial and contact information, including the company name, tax identification number, depository bank details, account type (checking or savings), bank transit/ABA number, and account number. The document mandates attaching a voided check and includes fields for the authorized representative's name, title, contact information, and signature. This ACH authorization remains in effect until written notification of termination is provided, ensuring a standardized electronic payment process for the dance floors and associated products procurement.
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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 .