8-Vendor Direct Deposit Authorization Form.pdf

PDF 195 KB Posted

Attached to
E-Rate Category Two Internal Connections – UPS Systems and Wireless Access Points
Solicitation number
RFP 25-26-18
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 or modify banking information for vendors receiving payments from the district. The document serves as a standardized template for vendors to authorize LFCISD to initiate direct deposit credits to their designated bank accounts. The form includes sections for vendors to provide their identification information, including name, tax ID, mailing address, contact person, phone number, and email address. Vendors must specify whether the submission represents a new account setup, a change to existing banking information, or cancellation of direct deposit services, along with an effective date for the transaction.

The banking information section requires vendors to identify their financial institution, account type (checking or savings), account number, and routing number, with instructions to provide either a bank direct deposit form or voided check for verification purposes. The certification section grants LFCISD authorization to initiate credits and corrections to vendor accounts, with the authority remaining in effect until the vendor provides written cancellation or upon termination of business with the district. Vendors bear responsibility for notifying LFCISD of any changes to banking information or discrepancies. The form includes an internal use section for LFCISD accounting personnel to document processing information, including the date processed, vendor ID number, and processor identification. The form references related vendor documentation requirements including new vendor request forms, W-9 forms, conflict of interest questionnaires, and federal compliance forms required when federal funds are expended by the district or its cooperative members.

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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 .