2020_ACH_FORM_(2).pdf

PDF 54 KB Posted

Attached to
RFQ - APPLIANCE MAINTENANCE AND REPAIR SERVICES
Solicitation number
25-S-023
Issued by
District of Columbia

About this file

This is an Authorization Agreement for Automatic Deposits (ACH Credits) form issued by the Washington Convention and Sports Authority (WCSA), also known as Events DC, located in the District of Columbia. The form establishes the mechanism through which qualified contractors selected for the Appliance Maintenance and Repair Services RFQ would receive payment from the government entity. The document requires the contractor to provide company name, Employer Identification Number (EIN) or Tax ID, banking information including depository name, branch location, transit/ABA number, and account number. The authorization grants WCSA the authority to initiate credit entries and, if necessary, debit entries and adjustments for erroneous credits to the contractor's designated checking or savings account.

The agreement remains in effect until WCSA receives written termination notification from the contractor, allowing both the company and depository reasonable time to process the cancellation. The form requires signature from an authorized representative, title, contact email, phone number, and date. A voided check must be attached to verify the banking information. This document is a standard requirement for contractors doing business with Events DC and ensures efficient payment processing for services rendered under the Appliance Maintenance and Repair Services contract, which is designated exclusively for District of Columbia Department of Small and Local Business Development (DSLBD) certified local, small, or disadvantaged business enterprises.

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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 .