3-Vendor Direct Deposit Authorization Form.pdf
PDF 195 KB Posted
- Attached to
- CTE Center IP Intercom System Replacement
- Solicitation number
- RFP 25-26-19
- Issued by
- Cameron County, Texas
About this file
This is a Vendor Direct Deposit Authorization Form issued by Los Fresnos Consolidated Independent School District (LFCISD) in Texas, updated November 1, 2023. The form is designed to establish direct deposit payment procedures for vendors conducting business with the district. The document serves as the authorization mechanism for the district to initiate electronic credits to vendor accounts and includes provisions for new direct deposit setups, changes to existing banking information, and cancellations of direct deposit arrangements. The form requires vendors to specify an effective date for the transaction and remains in effect until the vendor provides written cancellation notice to LFCISD or upon termination of the business relationship.
The form requires vendors to provide complete banking information including financial institution name, account type (checking or savings), account number, and routing number, with verification through submission of either a bank direct deposit form or voided check. Vendors must also designate a primary contact person and email address for electronic payment notifications. The vendor assumes responsibility for notifying LFCISD of any changes to banking information or discrepancies in payments. The form includes an internal processing section for LFCISD accounting personnel to record processing date and assign a vendor identification number. Additional required documentation referenced in the packet includes Form W-9, Form 1295, Conflict of Interest Questionnaire (CIQ), New Vendor Request Form, and vendor certification documents, indicating compliance with federal funding requirements when applicable to contracts awarded through the district's procurement process.
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U p d a t e d 1 1 - 1 - 2 3
Vendor Direct Deposit Authorization Form
Section I – Vendor Information
Vendor Name: ______________________ Tax ID#________________________
Mailing Address: ___________________________________________________
Vendor contact person: _____________________________________________
Phone Number: _____________________________________________________
E-mail:_______________________________________________________________ (Electronic Notification will be sent to email address listed for vendor payments)
Section II – Banking Information Type of Transaction:
( ) New ( ) Change ( ) Cancel Effective Date: _________________
Financial Institution: ______________________________________________________________
City, State, Zip Code: _____________________________________________________________
Type of Account: ( ) Checking ( ) Savings
Account #________________________________Routing # _______________________________
Note: Please provide bank direct deposit form or a “voided” check. (This will be used to verify bank transit routing number and bank account information.)
Section III – Certification I hearby authorize Los Fresnos Consolidated Independent School District (LFCISD) to initiate credits (and/or corrections to the previous credits) to my account listed above. This authority is in effect until I cancel it in writing giving LFCISD reasonable opportunity to act on it, or upon termination of our business.
It is my responsibility to inform LFCISD of any changes in our banking information or of any discrepancies.
Vendor Authorized Signature Phone Number Date
Section IV – Internal Use Only Processed by Accounting: ____________________ Date: _______________________
Vendor ID#_________________ sdelossantos Highlight
| New Vendor Request Form 11-15-23.pdf |
| _New Vendor Packet 11-1-23.pdf |
| New Vendor Request Form 11-1-23.pdf |
| ACH form 11-1-23.pdf |
| Form W-9.pdf |
| Vendor Certifications, CIQ, 1295, & COLI 11-1-23.pdf |
| _LFCISD Required Proposal Forms Template for Bids2.pdf |
| The following provisions are required and apply when federal funds are expended by Los Fresnos CISD, and/or its cooperative members, for any contract resulting from this procurement process. |
| _Form 1295.pdf |
| Form 1295 Changes.pdf |
| _Form CIQ Conflict of Interest Questionaire.pdf |
| coi-example.pdf |
| Vendor Name: |
| Tax ID: |
| Mailing Address: |
| Vendor contact person: |
| Phone Number: |
| Email: |
| Effective Date: |
| Financial Institution: |
| Account: |
| Routing: |
| Phone Number_2: |
| Processed by Accounting: |
| Date_2: |
| Vendor ID: |
| Date: |
| City State Zip Code: |
File details come from the government source that posted it. Updated .