EFT_FORM.pdf
PDF 418 KB Posted
- Solicitation number
- 24/25-119
- 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. The form is designed for individuals, businesses, or vendors to provide their banking information to authorize electronic credit and debit transactions with Clay County. The form requires the participant to provide their name, contact information, financial institution details, account type, routing number, and account number.
The form includes important instructions for both individuals and businesses, advising them to verify their complete EFT information with their financial institution. The authorization will remain in effect until canceled in writing, and participants are instructed to notify the Comptroller Department immediately if they close or change their bank account. The form requires an authorized signature and date to validate the EFT authorization.
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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 .