2020_ACH_FORM_.pdf
PDF 54 KB Posted
- Solicitation number
- 25-S-029
- 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 authorizes WCSA to initiate credit entries and, if necessary, debit entries and adjustments to a designated checking or savings account at a specified depository. The agreement remains in effect until WCSA receives written notification of termination, provided the notification allows WCSA and the depository reasonable time to process the request. The form requires the contractor to provide company name, EIN or Tax ID, depository information including transit/ABA number and account number, authorized signatory name and title, email for ACH notification, phone number, and signature. A voided check must be attached to complete the submission.
This form serves as a payment mechanism for vendors and contractors doing business with Events DC. The document does not specify contract amounts, funding sources, or pricing terms, as it is a standalone payment authorization agreement rather than a contract award or procurement solicitation document. Contractors are required to complete and submit this form to establish the banking details necessary for receiving payments from Events DC for contracted services or goods.
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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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