5-Supplier Direct Deposit Authorization Form 05-2025.pdf

292 KB Posted

Attached to
Computers and Accessories
Solicitation number
Bid 27008HCF
Issued by
Clark County, Fish Springs CDP, Nevada

About this file

Written by GovTribe AI ·

This is a Direct Deposit Authorization Form for suppliers providing goods or services to the Clark County School District in Nevada. The form serves as the official documentation required for vendors to authorize electronic payment of invoices through direct deposit banking arrangements. The form collects essential supplier information including company name, address, contact details, and banking information necessary to establish automated payment processing. Completion and submission of this authorization form is a prerequisite for participation in procurement activities with Clark County School District, ensuring that all approved invoices and payments can be processed efficiently through the district's accounts payable system.

The form requires suppliers to provide complete banking details including account holder name, bank name, routing number, account number, and account type to facilitate electronic fund transfers. This direct deposit arrangement streamlines the payment process and reduces administrative overhead associated with manual check processing. The authorization must be signed and dated by an authorized representative of the supplier company, and suppliers may be required to submit updated forms if banking information changes or if there is a break in business activity with the district. Acceptance and processing of the direct deposit authorization form does not guarantee contract award but is mandatory for vendors seeking to conduct business with Clark County School District.

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Supplier Direct Deposit (ACH) Authorization/Update Form Mail completed form with required attachment to:

Accounts Payable, 4190 McLeod Drive Las Vegas, NV 89121

Telephone: (702) 799-5360 Fax: (702) 799-5482

Supplier Main or Corporate Business Name & Address (as it appears on W-9) Information

Description of Request: New Change Federal Tax ID, SSN or Employee ID Number:

Name:

Address:

City: State: Zip Code:

CCSD Vendor Number: Telephone: Fax

Email Address for Notification of Payment:

Supplier Financial Institution Information (A copy of a Voided Check or Bank Letter is required to be attached)

Financial Institution Name: Telephone:

Address:

City: State: Zip Code:

Financial Institution Routing Number: Account Number:

Account Type: Checking Savings

Supplier Authorization- Signed in the presence of a Notary Public Supplier hereby authorize the Clark County School District to initiate direct deposit on my entire payment into my account. I further authorize the financial institution indicated above to credit the same to such account. This authority is to remain in full force and effect until the Clark County School District has received a new signed Direct Deposit Authorization Form and has a reasonable opportunity to act. I acknowledge that I am solely responsible for the accuracy of the account number and the financial institution ABA number that I have provided.

Supplier hereby cancels this authorization.

In witness, Whereof, I have hereunto set my hands this day of , 20

Printed Name and Title of Authorized Supplier Representative:

Signature : Date:

STATE OF , COUNTY OF This document was acknowledged before me on

(date)

By

Person appearing before notary Signature of notarial officer

Accounts Payable Internal Use Only

Accounts Payable Reviewer Initials: Verification date and time:

Telephone: Name and Title of Contact:

Administrator Approval Initials: Date submitted of Supplier Maintenance:

Notary Seal

Date of System Master Data Review: _____________________________

Revised 05-2025

Supplier Main or Corporate Business Name Address as it appears on W9 Information:
Change:
Federal Tax ID SSN or Employee ID Number:
Name:
Address:
City:
State:
Zip Code:
CCSD Vendor Number:
Telephone:
Fax:
Email Address for Notification of Payment:
Financial Institution Name:
Telephone_2:
Address_2:
City_2:
State_2:
Zip Code_2:
Financial Institution Routing Number:
Account Number:
Checking:
Savings:
undefined:
In witness Whereof I have hereunto set my hands this:
day of:
20:
Printed Name and Title of Authorized Supplier Representative:
Date:
STATE OF:
COUNTY OF:
before me on:
By:
Verification date and time:
Accounts Payable Reviewer Initials 1:
Accounts Payable Reviewer Initials 2:
Name and Title of Contact:
Administrator Approval Initials:
Date submitted of Supplier Maintenance:
Date of System Master Data Review:

File details come from the government source that posted it. Updated .