EFT Form20090922.doc
DOC document 86 KB Posted
- Attached to
- 15-9043-TELEPHONE
- Solicitation number
- BD-15-1025-DOCCF-FISCC-00000003359
- Issued by
- Middlesex County, Massachusetts
About this file
This document is an Electronic Funds Transfer (EFT) form from the Commonwealth of Massachusetts Department of Correction, Administrative Services/Concord Office. The form is used to provide vendor banking information, including Tax ID Number, vendor name, contact information, and bank account details for the purpose of setting up electronic payments. Vendors must complete all required fields, print the form, and submit it to the relevant department contact in order to establish or change their electronic payment information.
The related state and local contract opportunity is for a telephone-related service, identified as RFP 15-9043-TELEPHONE, located in the state of Massachusetts. No further details are provided about the specific products, services, quantities, response dates, award information, or contract term.
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Text version
The Commonwealth of Massachusetts Executive Order of Public Safety
Department of Correction, Administrative Services/Concord Office
P.O. Box 9125 – 965 Elm St. Bldg. #26
Concord, MA 01742-9125
Please complete all fields below, generate the form, print it and mail to your contact at the Department you do business with.
Top of Form
AUTHORIZED PERSON
First Name:
Name:
VENDOR INFORMATION
TIN * :
Vendor Name:
Contact Name:
E-mail:
Telephone:
Address:
City:
| State: |
| Zip: + |
VENDOR BANK INFORMATION
Bank Name:
Transit Number (ABA):
New Account Number:
| Old Account Number: |
| Filling out this field is a requirement for changing an account number |
| Account Type: |
| Checking Account Saving Account |
Fill all the fileds above, click "Print Form", and mail to the Department you do business with.
HTMLCONTROL Forms.HTML:Submitbutton.1
*TIN is your Tax ID Number
Signature______________________________ Date___________________
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File details come from the government source that posted it. Updated .