EFT form~5.doc
DOC document 52 KB Posted
- Attached to
- Habitat Management Grant FY19
- Solicitation number
- BD-19-1046-DFW-FW104-30884
- Issued by
- Worcester County, Duxbury CDP, Massachusetts
About this file
The document is an Electronic Funds Transfer (EFT) Sign Up Form from the Commonwealth of Massachusetts Office of the Comptroller. This form allows vendors to authorize the State Treasurer, as fiscal agent for the State of Massachusetts, to initiate, change, or cancel credit entries to their bank accounts. The form requires the vendor to provide their bank information, including the bank name, transit number, account number, and account type. The vendor must also provide their tax identification number, business name, contact information, and authorize the form with a signature.
The related state and local contract opportunity is the Habitat Management Grant FY19 from the Commonwealth of Massachusetts, Division of Fisheries and Wildlife (MassWildlife). This grant program seeks qualified applicants to participate in active habitat management on conserved lands in Massachusetts during Fiscal Year 2019. The grant program does not provide additional details on pricing, set asides, incumbents, funding requirements, or other salient information.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| DFW-2019-003 Request for Proposals_MassWildlife Habitat Management Grant Program.pdf | ||
| Questions and Answers~13.pdf | ||
| contractor authorized signature~5.doc | DOC document | |
| standard-contract-frm-03.21.14~42.doc | DOC document | |
| MHMGP_grantee budget form~2.xls | XLS spreadsheet | |
| MassWildlife Habitat Management Grant Application_Required Format for MS Word.docm | DOCM document | |
| MHMGP_ranking_criteria_FY19 final 8.31.18.doc | DOC document | |
| Comm TermsConditions~5.doc | DOC document | |
| newMass_W9~13.doc | DOC document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
COMMONWEALTH OF MASSACHUSETTS
OFFICE OF THE COMPTROLLER
Electronic Funds Transfer Sign Up Form
Request type must be checked:
FORMCHECKBOX
Initial Request
FORMCHECKBOX
Changing Existing Account
FORMCHECKBOX
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:
FORMCHECKBOX
I affirm that payments authorized hereunder are not to an account that is subject to being transferred to a foreign bank account.
FORMCHECKBOX
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 ether 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:
Filling out this field is a requirement for changing account #
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:
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 SIGNAUTRE:
Print Name:
Title:
Date:
Form forwarded to Commonwealth Department: Department of Fish and Game, Division of Fisheries and Wildlife � INCLUDEPICTURE "https://massfinance.state.ma.us/VendorWeb/images/seal.gif" \* MERGEFORMATINET ���
Attach voided check here. � � INCLUDEPICTURE "https://massfinance.state.ma.us/VendorWeb/images/voidCheck.gif" \* MERGEFORMATINET ����
File details come from the government source that posted it. Updated .