ACH form.pdf

This document is an Electronic Funds Transfer (EFT) and Automated Clearing House (ACH) Authorization Form from the Orange County Department of Finance, located in Goshen, New York. The form is designed to facilitate electronic payment methods for vendors doing business with the county, encouraging existing and new vendors to accept ACH payments instead of traditional paper checks. The document provides a mechanism for suppliers to authorize Orange County to initiate credit and debit entries to their specified bank account, with options to submit either a voided check or a bank letter/specification sheet as verification.

The form requires vendors to provide comprehensive contact and banking information, including supplier/vendor name, address, contact details, tax ID, bank routing number, and account information. Orange County notes that it may take one to two payment cycles before the first ACH payment is processed, and vendors are instructed to provide at least one valid email address for invoice details. The form explicitly states that no emailed applications can be accepted, and original forms must be returned to the finance department at the address provided. The document is signed by Kerry Gallagher, Commissioner of Finance, and includes contact information at 845-360-6666 for any questions about the payment process.