EFT_FORM.pdf
PDF 418 KB Posted
- Solicitation number
- 24/25-025
- Issued by
- Clay County, Harold CDP, Florida
About this file
The document is an Electronic Funds Transfer (EFT) Authorization Form from the Clay County Clerk of Court and Comptroller in Florida. The form is designed for individuals, businesses, or vendors to provide their banking information to enable electronic credit and debit transactions with Clay County. The form requires details such as the financial institution name, account type (checking, savings, or other), routing number, and account number, with space for the authorized signature and date.
This EFT authorization form is part of the administrative documentation related to a broader procurement process for a Computer-Aided Dispatch, Law Enforcement Records Management, and Jail Management System. The form serves as a standard payment mechanism for vendors participating in the Clay County contract opportunity, which involves multiple public safety agencies including the Clay County Sheriff's Office, Clay County Fire and Rescue, City of Green Cove Springs, and Town of Orange Park. The form emphasizes the importance of providing accurate banking information and notifying the Comptroller Department immediately of any account changes.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Computer-Aided_Dispatch,_Law_Enforcement_Records_Management_and_Jail_Management_System_(Addendum_#1_Revision).pdf | ||
| Attachment_B_-_Services_Proposed.docx | DOCX document | |
| Attachment_E_-_Jail_Management_System_Functional_Specifications_Final.xlsx | XLSX spreadsheet | |
| Attachment_G_-_References_Workbook.xlsx | XLSX spreadsheet | |
| Attachment_D_-_Law_Enforcement_RMS_Functional_Specifications.xlsx | XLSX spreadsheet | |
| Attachment_H_-_Exceptions_Workbook.xlsx | XLSX spreadsheet | |
| Attachment_C_-_CAD_MDS_Functional_Specifications.xlsx | XLSX spreadsheet | |
| Attachment_F_-_Pricing_Forms.xlsx | XLSX spreadsheet | |
| Attachment_A_-_Solution_Proposed.docx | DOCX document | |
| Certificate_of_partial_payment.pdf | ||
| W-9_(2024).pdf | ||
| Certificate_of_final_payment.pdf | ||
| Chapter_8_Section_I_(1).pdf |
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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 .