4-Vendor Direct Deposit Authorization Form.pdf
PDF 195 KB Posted
- Solicitation number
- RFP 26-27-07
- Issued by
- Cameron County, Texas
About this file
This is a Vendor Direct Deposit Authorization Form used by Los Fresnos Consolidated Independent School District (LFCISD) in Texas to establish and manage vendor payment methods. The form facilitates the setup, modification, or cancellation of direct deposit banking information for vendors conducting business with LFCISD. Vendors must complete vendor information including name, tax identification number, mailing address, and contact details in Section I. Section II requires vendors to specify the transaction type and provide banking information, including the financial institution name, account type, account number, and routing number, with supporting documentation such as a voided check or bank direct deposit form to verify accuracy. The form applies to the Professional Consultant Services for Education Professional Development procurement solicitation, which seeks qualified vendors to provide consulting services on an as-needed basis across various disciplines including keynote speaking, professional development, strategic planning, instructional coaching, curriculum development, assessment and evaluation, leadership development, and teacher induction programs.
Section III requires the vendor's authorized representative to certify the authorization, which remains effective until written cancellation is provided to LFCISD or upon business termination. The vendor assumes responsibility for notifying LFCISD of any changes to banking information or discrepancies. Section IV is designated for internal accounting use and includes fields for processing documentation, vendor identification number, and date of processing. The form was last updated on November 1, 2023, and must be submitted as part of the required vendor packet documentation, which includes the New Vendor Request Form, Form W-9, Form 1295, Conflict of Interest Questionnaire (CIQ), and other vendor certifications. No specific pricing terms, contract amounts, or award dates are detailed within this authorization form.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
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 .