EFT_FORM HSD FY15-05.pdf
PDF 43 KB Posted
- Attached to
- HSD FY21-06, Meat and Cheese Bid
- Solicitation number
- BD-21-1057-HSD01-HSPMT-58868
- Issued by
- Massachusetts
About this file
The provided document is an Electronic Funds Transfer Sign Up Form from the Commonwealth of Massachusetts Office of the Comptroller. The form allows vendors to provide their banking information to the State Treasurer to facilitate electronic payments. The form requires vendors to provide their tax ID, business name, contact information, and bank account details including the account type and routing number. Vendors must also certify that the bank account is under their direct control and affirm whether the account is subject to being transferred to a foreign bank account.
The related state and local contract opportunity is for a Meat and Cheese Bid (HSD FY21-06) issued by the state of Massachusetts. The contract appears to be for the procurement of meat and cheese products, but does not provide specifics on item quantities, response dates, award timelines, or contract term.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| TAX COMPLIANCE CERTIFICATION~1.docx | DOCX document | |
| Meat and Cheese Bid Specifications HSD FY21-06.rtf | RTF text file | |
| Prompt Payment Discount Form~1.doc | DOC document | |
| Business Reference Form HSD FY15-05.doc | DOC document | |
| Contractor Authorized Signatory Form HSD FY15-05.doc | DOC document | |
| CERTIFICATE OF NON-COLLUSION~1.docx | DOCX document | |
| Meat and Cheese Bid Sheet - HSD FY21-06.xls | XLS spreadsheet | |
| w-9 HSD FY15-05.doc | DOC document |
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Text version
COMMONWEALTH OF MASSACHUSETTS
OFFICE OF THE COMPTROLLER
Electronic Funds Transfer Sign Up Form
This form should be sent to a department with whom you do business.
Request type must be checked: Initial Request Changing Existing Account Closing Account
I , hereby certify that the account/s indicated on this form is under my direct control and access; therefore, I authorize the State Treasurer as fiscal agent for the State of Massachusetts to initiate, change or cancel credit entries to that account/s as indicated on this form. For ACH debits consistent with the International ACH Transaction (IAT) rules check one:
I affirm that payments authorized hereunder are not to an account that is subject to being transferred to a foreign bank account.
I affirm that payments authorized hereunder are to an account that is subject to being transferred to a foreign bank account.
This authority is to remain in full force and effect until the Office of Comptroller has received written notification, from either me or an authorized officer of organization of the account's termination in such time and in such a manner as to afford CTR a reasonable opportunity to act upon it.
VENDOR BANK INFORMATION
Vendor Bank Name:
Vendor Bank Transit Number (ABA):
Vendor Bank Account Number:
Account Type:
Filling out this field is a requirement for changing account number Vendor Bank Old Account Number:
Account Type:
VENDOR INFORMATION
Vendor Tax Identification Number (TIN):
Vendor/Business Name:
Vendor Contact Name:
E-mail:
Telephone:
Address:
City:
State:
Zip:
This authorization will remain in effect until either canceled in writing or an updated form changing information is sent to the Department you currently do business with.
AUTHORIZED SIGNATURE:
Print Name:
Title:
Date:
Form forwarded to Commonwealth Department:
Attached voided check here:
File details come from the government source that posted it. Updated .