EFT_FORM.pdf

PDF 418 KB Posted

Attached to
Disaster Debris Removal Services State and local contract opportunity
Solicitation number
25/26-018
Issued by
Clay County, Harold CDP, Florida

About this file

This is an Electronic Funds Transfer (EFT) Authorization Form issued by the Clay County Clerk of Court and Comptroller in Florida for processing vendor payments. The form authorizes Clay County Comptroller's office and the vendor's designated financial institution to initiate electronic credits and, if necessary, debit entries and adjustments for erroneous credits. The authorization remains in effect until the vendor cancels it in writing with the Comptroller Department. Vendors must provide complete banking information including the financial institution name, account type (checking, savings, or other), transit/ABA/routing number, and account number. The form requires vendor signature and date to become effective, and vendors are instructed to notify the Comptroller Department immediately if they close or change their bank account.

This form is directly related to Clay County's Request for Bids (RFB #25/26-018) for disaster debris removal services, where successful contractors will likely be required to complete EFT authorization to receive payments for debris removal, reduction, and disposal services. The County anticipates awarding up to three contractors for comprehensive debris removal following presidentially declared disaster events, with work performed on a unit cost basis per cubic yard delivered to designated disposal sites. Payment processing through electronic funds transfer is a standard requirement for vendors contracting with Florida government agencies, ensuring efficient and secure disbursement of compensation for services rendered under the five-year contract with optional one-year renewal periods.

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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 .