2020_ACH_FORM.pdf

PDF 54 KB Posted

Attached to
PURCHASE AND/OR RENTAL OF GATORS AND GOLF CARTS
Solicitation number
25-S-068
Issued by
District of Columbia

About this file

This is an Authorization Agreement for Automatic Deposits (ACH Credits) form related to the District of Columbia's Purchase and/or Rental of Gators and Golf Carts solicitation managed by Events DC through the Washington Convention and Sports Authority (WCSA). The form authorizes WCSA to initiate credit entries and, if necessary, debit entries and adjustments to a contractor's designated checking or savings account at a specified depository financial institution. The agreement remains in effect until WCSA receives written termination notification that provides 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 bank name, branch, city, state, ZIP code, transit/ABA number, and account number. The authorized representative must sign and date the form and provide contact information including name, title, email, phone number, and a voided check attachment to verify the banking details. This document serves as the payment authorization mechanism for contractors awarded under the gators and golf carts procurement.

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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 .