2020_ACH_FORM_(2).pdf

PDF 54 KB Posted

Attached to
RFQ- EVENT ACTIVATIONS AND ENTERTAINMENT SERVICES
Solicitation number
25-S-011
Issued by
District of Columbia

About this file

This document is an Authorization Agreement for Automatic Deposits (ACH Credits) form used by the Washington Convention and Sports Authority (WCSA). The form serves as a banking authorization template that allows WCSA to initiate electronic credit entries (payments) and necessary debit adjustments to a contractor's or vendor's designated checking or savings account. The agreement remains in effect until written termination notice is provided with reasonable time for processing, and requires the submission of a voided check along with complete banking information including depository name, branch, routing number, and account number.

The form requires comprehensive company and contact information including business name, EIN or Tax ID number, authorized signatory details with title, email addresses for ACH notifications, and phone number. All fields are currently blank as this is a template form to be completed by potential contractors or vendors who will receive electronic payments from WCSA. The document emphasizes the requirement to attach a voided check to verify banking details and includes the DC Events logo, indicating this may be related to event management services or convention activities managed by the Washington Convention and Sports Authority.

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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 .