EFT_FORM.pdf
PDF 418 KB Posted
- Solicitation number
- 25/26-002
- 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. The form is designed for individuals, businesses, or vendors to provide their banking information to enable electronic credit and debit transactions with the county. The form requires the completion of key details including the account holder's name, contact information, financial institution, account type, routing number, and account number.
The authorization allows Clay County Comptrollers to initiate electronic credits and, if necessary, make adjustments for any credit entries in error. The authorization remains in effect until cancelled in writing by the account holder, who is advised to notify the Comptroller Department immediately if they close or change their bank account. The form provides guidance for both individuals and businesses to ensure they have the correct EFT/ACH information from their financial institution, such as obtaining a direct deposit letter or a voided check to verify account details.
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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 .