EFT_FORM.pdf

PDF 418 KB Posted

Attached to
Continuing Services for Sidewalk, Driveway & Concrete Improvements
Solicitation number
25/26-099
Issued by
Clay County, Harold CDP, Florida

About this file

This is an Electronic Funds Transfer (EFT) Authorization Form issued by the Clay County Clerk of Court and Comptroller in Florida for use by contractors, vendors, and businesses receiving payments from Clay County. The form authorizes Clay County Comptroller's office and the vendor's designated financial institution to initiate electronic credit entries and, if necessary, debit entries for error corrections. The authorization remains in effect until the vendor submits written cancellation to the Comptroller Department. Vendors are required to provide complete banking information including the financial institution name, account type (checking, savings, or other), routing/ABA number, and account number. The form applies to the Clay County Board of County Commissioners' Request for Bids for continuing, as-needed concrete construction services including sidewalk, driveway, curb, curb ramp, gutter, and related concrete improvement work at various county locations.

Vendors must notify the Comptroller Department immediately if their bank account is closed or changed. Individuals uncertain about their EFT information are directed to contact their financial institutions for direct deposit letters or voided checks, while businesses and vendors should contact their institutions for complete ACH/EFT details. The form requires an authorized signature and date. This EFT authorization is a standard requirement for payment processing and does not address pricing, set-asides, contract terms, or other substantive bid conditions related to the concrete services contract opportunity.

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Text version

Clay County Clerk of Court and Comptroller

EFT Authorization Form

Individual/Business/Vendor Name: (Please Print)

Phone Number:

Email:

I/We hereby authorize Clay County Comptrollers and the financial institution listed below to initiate electronic credits, and, if necessary, debit entries and adjustments for any credit entries in error. This authority will remain in effect until I cancel it in writing to the Comptroller Department. *Notify the Comptroller Department immediately if you close or change Bank Account*

Account Information:

Financial Institution:

Type of Account (please circle one): Checking Savings Other:______________

Transit / ABA / Routing #:

Account Number:

*Individuals: If you are unsure of your complete EFT information please contact your financial institution. In most cases, your financial institution can provide you with a direct deposit/EFT letter or a voided check.

Businesses/Vendors: Please check with your financial institution for your complete ACH/EFT information.

Authorized Signature:_______________________________ Date: ___________

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