EFT form.docx
DOCX document 29 KB Posted
- Attached to
- DCR FAC 104 Scusset Gazebo
- Solicitation number
- BD-20-1020-DCRCU-DC250-51768
- Issued by
- Barnstable County, Massachusetts
About this file
The document provided is an Electronic Funds Transfer (EFT) Sign Up Form for the Commonwealth of Massachusetts Office of the Comptroller. This form allows vendors to authorize the State Treasurer, as fiscal agent for the State of Massachusetts, to initiate, change, or cancel credit entries to their bank account. The form requires the vendor's bank information, including the bank name, transit number, account number, and account type. Additionally, the vendor must provide their tax identification number, business name, contact information, and address.
The related state and local contract opportunity is for the Department of Conservation and Recreation (DCR) FAC 104 Scusset Gazebo project, located in the state of Massachusetts. The project involves the purchase and installation of a gazebo, engineered wood fiber (EWF), a picnic table, and stone dust.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| DCR FAC 104 Scusset Gazebo~2.docx | DOCX document | |
| COMMBUYS create-a-quote-v1~4.docx | DOCX document | |
| promptpaydiscountform.docx | DOCX document | |
| eppform~5.docx | DOCX document | |
| w-9 form march 2020.pdf | ||
| busreffm.doc | DOC document | |
| StandardContractFormAndInstructions.pdf | ||
| CASL_Form.rtf | RTF text file |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
COMMONWEALTH OF MASSACHUSETTS
OFFICE OF THE COMPTROLLER
Electronic Funds Transfer Sign Up Form
Request type must be checked: Initial Request Changing Existing Account Closing Account
I_________________________, hereby certify that the account/s indicated on this form is under my direct control and access; therefore, I authorize the State Treasurer as fiscal agent for the State of Massachusetts to initiate, change or cancel credit entries to that account/s as indicated on this form.
For ACH debits consistent with the International ACH Transaction (IAT) rules check one:
I affirm that payments authorized hereunder are not to an account that is subject to being transferred to a foreign bank account.
I affirm that payments authorized hereunder are to an account that is subject to being transferred to a foreign bank account.
This authority is to remain in full force and effect until the Office of Comptroller has received written notification, from ether me or an authorized officer of organization of the account's termination in such time and in such a manner as to afford CTR a reasonable opportunity to act upon it.
VENDOR BANK INFORMATION
| Vendor Bank Name: |
| _________________________ |
Vendor Bank Transit Number (ABA): _________________________
| Vendor Bank Account Number: |
| _________________________ |
Filling out this field is a requirement for changing account number
| Vendor Bank Old Account Number: |
| _________________________ |
| Account Type: |
| _________________________ |
VENDOR INFORMATION
Vendor Tax Identification Number (TIN):________________________
| Vendor/Business Name: |
| _________________________ |
| Vendor Contact Name: |
| _________________________ |
| E-mail: |
| _________________________ |
| Telephone: |
| _________________________ |
| Address: |
| _________________________ |
| City: |
| _________________State: ______Zip:__________ |
This authorization will remain in effect until either canceled in writing or an updated form changing information is sent to the Department you currently do business with.
AUTHORIZED SIGNATURE: ______________________________________________________
Print Name: ______________________ Title:______________________ Date: __________ Form forwarded to Commonwealth Department:____________________________________ Attached voided check here:
image1.jpeg image2.jpeg image3.jpeg
File details come from the government source that posted it. Updated .