ACH form.pdf

This document is an Electronic Funds Transfer (EFT) & Automated Clearing House (ACH) Authorization Form from the Orange County Department of Finance, located in Goshen, New York. The form is designed for vendors to set up electronic payment methods for doing business with Orange County, allowing them to receive payments directly into their bank account instead of traditional paper checks. The document provides clear instructions for new and existing vendors to complete the authorization process, emphasizing that original forms are required and no emailed applications will be accepted.

The form requires vendors to provide comprehensive details including contact information, bank account details, and email addresses for payment notifications. Vendors must select their status (OC Employee, Existing County Supplier, or New County Supplier) and choose between a new ACH application or updating existing information. The form notes that it may take one to two payment cycles before the first ACH payment is processed, and vendors are advised to contact the finance office with any questions. The document is signed by Kerry Gallagher, Commissioner of Finance, and includes the county executive's name (Steven M. Neuhaus) at the top of the letterhead.