2020_ACH_FORM.pdf

PDF 54 KB Posted

Attached to
CLOSED CAPTION SERVICES
Solicitation number
25-S-067
Issued by
District of Columbia

About this file

This is an Authorization Agreement for Automatic Deposits (ACH Credits) form from the Washington Convention and Sports Authority (WCSA) related to a Closed Caption Services contract opportunity issued by Events DC in the District of Columbia. The form authorizes WCSA to initiate credit entries and, if necessary, debit entries and adjustments to correct erroneous credits to a designated checking or savings account at a specified depository. The agreement remains in effect until WCSA receives written termination notice providing the company and depository reasonable time to process the cancellation.

The form requires the contractor to provide standard business information including company name, EIN or Tax ID, depository details (name, branch, city, state, zip code, transit/ABA number, and account number), and contact information for ACH notifications. The authorized representative must sign the form and provide their name, title, email address, phone number, and date of authorization. A voided check must be attached to the form to verify banking information. This document serves as a prerequisite administrative requirement for payment processing under the closed captioning services contract.

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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 .