County_of_Orange_Electronic_Funds_Transfer_(EFT)_Authorization_Form.pdf

YOU CAN WITH ORANGE COUNTY’S

ELECTRONIC FUNDS TRANSFER

GET PAID FASTER

Did you know that you could be receiving your payments faster, more reliably and more securely with Orange County’s Electronic Funds Transfer (EFT)? By simply signing up for this free service your company will receive payment from the County directly to the checking or savings account of your choice. No waiting for delivery, lost or stolen checks, or trips to the bank. You’ll enjoy quicker access to funds securely deposited to your account by the County of Orange. Simply fi ll out the form on the back of this page, mail it along with an original voided check to the County of Orange Auditor-Controller and you’ll begin enjoying all the benefi ts that come along with the convenience and peace of mind EFT off ers.

Complete the Electronic Funds Transfer (EFT) Authorization Form on the back of this page. For companies with multiple remittance addresses, separate forms are required for each address seeking to establish EFT.

• Quicker access to your funds

• Avoid postal delays

• Receive an email confi rmation (remittance advice) with each deposit

• Studies show that EFTs are 7 times more secure than check payments

• Thousands of our vendors are already receiving EFT payments

• Your information is kept securely maintained and confi dential

Attach an original voided check or savings withdrawal slip from your fi nancial institution (deposit slips are not acceptable).

Return the completed EFT Authorization Form and original voided check or withdrawal slip to the OC Auditor-Controller.

Setting up your EFT is free and simple:

SIGN UP TODAY! Enjoy the Benefits:

WE BET YOU’D RATHER

Questions? Please contact Compliance Unit at (714) 834-3503 or via email: Admin.Vendor@ac.ocgov.com

COUNTY OF ORANGE

(For US Vendors Only)

Electronic Funds Transfer (EFT) Authorization Form

Vendor/Customer Code (if known):

Vendor Name:

Vendor Address (Remittance Address):

Vendor EIN or Social Security Number:

County Department you have a contract, agreement, or do business with:

County Department Contact Name:

County Department Contact Phone Number:

DIRECT DEPOSIT INFORMATION (MUST BE A US BASED FINANCIAL INSTITUTION):

ABA Routing Number (9 digits) AND Account Number:

Account Name/Description:

Financial Institution Name:

Address:

Account Type (select one): rChecking Account rSavings Account

This Account is a (select one): rBusiness Account rPersonal Account

I hereby authorize the County of Orange to initiate a deposit entry.

Authorized By:(2)

Name

Title

Signature

Phone Number

Date

Payment Remittance Contact Person:

Name

Title

Phone Number

Email (required)*

* An electronic payment remittance will be sent to this email address.

(1): Remittance address must match with the address shown on invoice.

(2)The Authorized By and Payment Remittance Contact Person should be two separate persons unless the form is signed by a high ranking officer such as CEO, CFO, Treasurer, etc.

(3): This only applies to new EFT set up or change of bank information. For change of Payment Remittance Contact Person, you will just need to fill in the EFT Authorization Form and email it to Vendor Admin. No Voided Check or Withdrawal Slip needed.

Mail Completed Form & Original Voided Check (or Withdrawal Slip) to:(3)

County of Orange Auditor-Controller ATTN: Claims Compliance Unit

1770 N. Broadway, Santa Ana, CA 92706 QUESTIONS? Email: Admin.Vendor@ac.ocgov.com

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