5-Vendor Direct Deposit Authorization Form.pdf
PDF 195 KB Posted
- Attached to
- Custodial Supplies & Small Equipment
- Solicitation number
- RFP 26-27-12
- 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 methods for vendors conducting business with the district. It serves as a supporting document within the district's new vendor onboarding process, which includes additional requirements such as the New Vendor Request Form, W-9 tax documentation, conflict of interest questionnaires (Form CIQ), and Form 1295 certifications. The form functions as part of the district's vendor management system and must be completed by all vendors seeking to receive payments through automated clearing house (ACH) transactions.
The form contains four sections addressing vendor information, banking details, vendor certification, and internal accounting processing. Vendors must provide their legal name, tax identification number, mailing address, contact information, and email address for electronic payment notifications. Banking information includes the account type (checking or savings), account number, routing number, and effective date for the direct deposit arrangement. Vendors are required to submit supporting documentation such as a bank direct deposit form or voided check to verify routing and account information. The authorization remains in effect until the vendor submits written cancellation or the business relationship terminates, and vendors bear responsibility for notifying LFCISD of any changes to banking information or payment discrepancies. The form is processed through the district's accounting department, which assigns a vendor identification number upon completion.
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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 .