2020_ACH_FORM.pdf
PDF 54 KB Posted
- Attached to
- CLOSED CAPTION SERVICES
- Solicitation number
- 25-S-055
- Issued by
- District of Columbia
About this file
This is an Authorization Agreement for Automatic Deposits (ACH Credits) form related to a Closed Caption Services contract opportunity with the Washington Convention and Sports Authority (WCSA) and the District of Columbia. The form establishes the mechanism for payment processing by authorizing WCSA to initiate credit entries and, if necessary, debit entries and adjustments to a designated checking or savings account at a specified depository institution. The authorization remains in effect until written termination notice is provided to both WCSA and the depository with sufficient time to process the cancellation.
The form requires the contractor to provide company name, EIN or Tax ID, depository information including bank name, branch location, transit/ABA number, and account number, along with contact information including name, title, email, phone number, and signature. A voided check must be attached to verify banking details. This document serves as a standard financial setup requirement for contractors awarded District of Columbia Department of Small and Local Business Development (DSLBD) certified local, small, or disadvantaged business enterprises seeking to provide closed captioning services through Events DC.
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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 .