ACH_FORM.pdf

PDF 54 KB Posted

Attached to
Purchase and Installation of Service Corridor Flooring Services
Solicitation number
25-S-064
Issued by
District of Columbia

About this file

This is an Authorization Agreement for Automatic Deposits (ACH Credits) form issued by the Washington Convention and Sports Authority (WCSA), also known as Events DC, located in the District of Columbia. The form is designed to authorize WCSA to initiate credit entries and, if necessary, debit entries and adjustments to a contractor's designated checking or savings account at a specified depository. The authorization grants WCSA the authority to process automatic deposits for contract payments and remains in effect until the contractor provides written termination notice that allows both WCSA and the depository reasonable time to act upon it.

The form requires the contractor to provide essential banking information, including the company name, EIN or Tax ID, depository name and branch location, transit/routing number, and account number. The contractor must also provide contact information including name, title, email address, phone number, and signature, along with a voided check attached as verification of the banking details. This ACH authorization form is a standard administrative requirement for contractors working with WCSA on projects such as the Purchase and Installation of Service Corridor Flooring Services at the Walter E. Washington Convention Center, which includes a thirty-five percent set-aside for Certified Business Enterprises as required under District of Columbia law.

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Text version

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS (ACH CREDITS)

COMPANY NAME: _____________________________________

EIN or Tax ID of the Business: ________________________________________

I (we) hereby authorize Washington Convention and Sports Authority (WCSA), hereinafter called COMPANY, to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries in error to my (our) Checking Savings account (select one) indicated below and the depository named below, hereinafter called DEPOSITORY, to credit and/or debit the same to such account.

DEPOSITORY

NAME BRANCH

CITY STATE ZIP

TRANSIT/ABA NO. ACCOUNT NO.

This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

NAME: __ TITLE: _______________________

Email for ACH Notification: ______________________ cc: ___________________________

PHONE #: __________________________________ DATE: ________________________

SIGNATURE:

*** ATTACH A VOIDED CHECK ***

File details come from the government source that posted it. Updated .