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 enable vendors to switch from receiving paper checks to electronic payments through ACH. Vendors are required to complete the form with their banking and contact information, selecting either a new ACH application or updating existing ACH information. The document emphasizes that original forms are mandatory and email applications will not be accepted.

The form requires vendors to provide detailed information including supplier/vendor name, contact details, bank routing and account numbers, and email addresses for invoice notifications. The county notes that it may take one to two payment cycles before the first ACH payment is processed. Vendors must choose between submitting a voided check or a bank letter/specification sheet with a local bank representative's signature to validate their banking information. The form is signed by Kerry Gallagher, Commissioner of Finance, and provides a phone number (845-360-6666) for vendors with questions about the payment process.