2020_ACH_FORM.pdf

PDF 54 KB Posted

Attached to
TRAINING AND CERTIFICATION ON FIRST AID, CPR & AED
Solicitation number
25-S-054
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) for use by contractors and vendors conducting business with the organization. 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 authorization remains in full force and effect until WCSA receives written notification of termination, provided such notice allows WCSA and the depository reasonable opportunity to act upon it. The form requires the contractor to provide company name, EIN or Tax ID, depository information including name, branch location, transit/ABA number, and account number, along with contact information including name, title, email, phone number, and signature.

The form is a standard administrative requirement for payment processing and does not address pricing terms, contract awards, or project-specific details. Contractors must attach a voided check to verify banking information accuracy. This ACH authorization is associated with Events DC's request for qualified contractors to provide First Aid, CPR, and AED training and certification services at the Washington Convention Center and other Events DC-managed venues in the District of Columbia. The RFQ 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 .