2020_ACH_FORM_(4)_(1).pdf
PDF 54 KB Posted
- Attached to
- Executive Recruitment Services
- Solicitation number
- 25-S-059
- 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, in the District of Columbia. The form establishes the procedural requirements for contractors to authorize automatic electronic fund transfers to their designated banking accounts for payment of contract services. The agreement permits WCSA to initiate credit entries directly to a contractor's checking or savings account at their specified depository and to make any necessary debit entries or adjustments for erroneous credits. The authorization remains in effect until WCSA receives written termination notification from the contractor, provided the notice allows the company and depository reasonable time to process the cancellation.
Contractors completing this form must provide their company name, EIN or Tax ID, depository information including the bank name, branch location, routing number (transit/ABA), and account number, along with contact information including name, title, email address, phone number, and signature. A voided check must be attached to the form to verify banking information. This ACH authorization form is a standard administrative requirement associated with WCSA's Executive Recruitment Services solicitation, which targets small, certified business enterprises certified by the District of Columbia Department of Small, Local, and Business Development (DSLBD).
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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 ***
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