2020_ACH_FORM.pdf
PDF 54 KB Posted
- Solicitation number
- 25-S-048
- 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) in the District of Columbia for vendors providing Medical and Infectious Waste Pickup and Disposal Services. The form authorizes WCSA to initiate credit entries and, if necessary, debit entries and adjustments to a vendor's designated checking or savings account at a specified depository financial institution. The authorization remains in full force and effect until WCSA receives written termination notice from the vendor, allowing both WCSA and the depository reasonable time to process the termination.
The form requires vendors to provide their company name, EIN or Tax ID, depository information including branch location, ABA transit number, and account number, along with contact details including name, title, email, and phone number. Vendors must sign and date the authorization and attach a voided check to verify banking information. An email address for ACH notifications may be provided, and an optional CC email address is available for documentation purposes. This standard banking authorization is necessary for WCSA to process vendor payments electronically for services rendered to the Convention Center, a 2.3 million square foot facility in Washington, D.C. that hosts approximately 200 events annually.
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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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