8-Vendor Direct Deposit Authorization Form.pdf
PDF 195 KB Posted
- 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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Text version
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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 .