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 to facilitate electronic payment processes for vendors doing business with the county, encouraging existing and new vendors to accept ACH payments instead of traditional check payments. Vendors are instructed to complete the form with their banking and contact information, select their vendor status (OC Employee, Existing County Supplier, or New County Supplier), and provide either a voided check or bank letter for verification.

The form requires vendors to provide detailed information including company name, contact details, address, tax ID, and bank account information for either checking or savings accounts. One to two email addresses must be provided for invoice details, and the form must be signed by an authorized representative. The document notes that it may take one to two payment cycles before the first ACH payment is processed, and original forms are required to be submitted to the finance department. The form is signed by Kerry Gallagher, Commissioner of Finance, and includes contact information at 845-360-6666 for any questions about the payment process.