EFT_FORM.pdf
PDF 418 KB Posted
- Attached to
- Moody Park National Fitness Campaign Slab
- Solicitation number
- 24/25-126
- Issued by
- Clay County, Orlando City, Florida
About this file
The document is an Electronic Funds Transfer (EFT) Authorization Form from the Clay County Clerk of Court and Comptroller. This form enables individuals, businesses, or vendors to authorize electronic credits and, if necessary, debit entries to their financial account. The form requires the submission of key banking details, including the financial institution name, account type (checking, savings, or other), routing number, and account number.
The form provides instructions for both individuals and businesses to complete their EFT information, recommending contact with their financial institution to obtain precise details like a direct deposit/EFT letter or voided check. The authorization will remain in effect until cancelled in writing, and the form emphasizes the importance of notifying the Comptroller Department immediately if the bank account is closed or changed. The document includes a space for the authorized signature and date, serving as a formal consent for electronic fund transfers.
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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 .