EFT_FORM.pdf
PDF 418 KB Posted
- Attached to
- Cellular Professional Archiving
- Solicitation number
- 24/25-105
- Issued by
- Clay County, Harold CDP, Florida
About this file
The document is an Electronic Funds Transfer (EFT) Authorization Form issued by the Clay County Clerk of Court and Comptroller in Florida. This standard form allows individuals, businesses, or vendors to provide their banking information to enable electronic payment processing. The form requires details such as the account holder's name, contact information, financial institution, account type (checking, savings, or other), routing number, and account number.
The form authorizes Clay County Comptrollers to initiate electronic credits and, if necessary, make adjustments for any erroneous credit entries. The authorization remains in effect until canceled in writing by the account holder, who is advised to notify the Comptroller Department immediately if they close or change their bank account. The document includes guidance for both individuals and businesses to verify their complete EFT information with their financial institution, recommending obtaining a direct deposit/EFT letter or a voided check to ensure accuracy.
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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 .