ACH form.pdf

The 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 new and existing vendors to set up electronic payment methods for transactions with Orange County, specifically in relation to a potential contract for perinatal healthcare items. The form allows vendors to authorize the county to make direct credit or debit entries to their specified bank account, with the goal of replacing paper check payments.

The form requires vendors to provide comprehensive business and banking information, including contact details, tax identification, 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. The document emphasizes that only original forms will be accepted, with a strict policy of not accepting emailed applications. Vendors must choose whether they are a new or existing county supplier and whether they are submitting a new ACH application or updating existing information.