EFT_FORM.pdf
PDF 418 KB Posted
- Solicitation number
- 24/25-089
- Issued by
- Clay County, Orlando City, Florida
About this file
The document is an Electronic Funds Transfer (EFT) Authorization Form issued by the Clay County Clerk of Court and Comptroller, designed for individuals, businesses, and vendors to provide banking details for electronic payment processing. The form requires the completion of key information including the entity's name, contact details, financial institution information, account type, routing number, and account number, with space for an authorized signature and date.
The form authorizes Clay County Comptrollers to initiate electronic credits and, if necessary, make debit entries or adjustments for any credit errors. The authorization remains in effect until canceled in writing, and the form includes guidance for both individuals and businesses to verify their complete EFT information with their financial institution. While this specific form is associated with a home rehabilitation project at 202 Foxridge Road in Orange Park, Florida, its primary purpose is to establish a standardized method for electronic payment processing for the county.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| CDBG_-_202_Foxridge_Road_Home_Rehabilitation_(Re-Bid).pdf | ||
| Warranty_Letter_.pdf | ||
| W-9_(2024).pdf | ||
| Certificate_of_final_payment.pdf | ||
| Certificate_of_partial_payment.pdf | ||
| Performance_&_Payment_Bond.doc | DOC document |
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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 .