5-Vendor Direct Deposit Authorization Form.pdf
PDF 195 KB Posted
- Attached to
- Theater & Fine Arts Products or Related Services
- Solicitation number
- RFP 26-27-05
- 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, as part of the district's vendor management processes for the Theater & Fine Arts Products or Related Services procurement. The form serves as the standardized document for establishing or modifying payment methods for qualified vendors providing theater and fine arts equipment, supplies, materials, and related services to support the district's performing arts programs across all facilities. The form accommodates three transaction types: new vendor setup, changes to existing banking information, or cancellation of direct deposit authorization, with vendors required to specify an effective date for the transaction.
The form requires vendors to provide complete banking information including financial institution details, account type (checking or savings), account number, and routing number, with supporting documentation such as a bank direct deposit form or voided check required for verification purposes. Vendors must authorize LFCISD to initiate credits and corrections to their designated account and are responsible for notifying the district of any changes to banking information or discrepancies. The authorization remains in effect until the vendor provides written cancellation notice or upon termination of the business relationship. The form includes sections for vendor identification (name, tax ID, mailing address, contact person, phone, email), banking information, vendor certification with authorized signature, and internal accounting use for processing and tracking with vendor ID assignment.
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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 .