EFT_FORM.pdf
PDF 418 KB Posted
- Attached to
- Construction of Radar Road
- Solicitation number
- 25/26-010
- Issued by
- Clay County, Harold CDP, Florida
About this file
This 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 financial transactions with Clay County. The form requires the participant to provide their contact details, financial institution information, account type, routing number, and account number, and authorizes the county 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 form includes guidance for both individuals and businesses, recommending they consult their financial institution to confirm complete EFT or ACH information. A signature and date are required to validate the authorization, and the form includes the Clay County Clerk of Court and Comptroller's official seal, indicating its official nature.
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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 .