Exhibit C EFT Authorization Form 082017.pdf

This is an EFT Direct Deposit Authorization Form for the State of Colorado used to establish, modify, or terminate electronic fund transfer arrangements for vendor payments. The form captures essential banking and payee information required for the state to process direct deposit payments to contractors and vendors. Section I collects state department payor information including the department name, customer number, and mailing address. Section II requests complete payee and vendor details including the vendor name, doing business as designation, mailing address, email, and phone number. Section III requires depository institution information such as the bank name, branch address, routing number, account number, and account type (checking or savings), with vendors required to submit a voided check or signed bank letter documenting these banking details. The form also requests the payee's taxpayer identification number and clarifies whether all payments to that taxpayer ID should utilize the specified bank account.

Section IV provides authorization options for vendors to set up new direct deposit arrangements, modify existing banking information, or cancel EFT enrollment. For modification requests, vendors must provide their existing routing and account numbers. The authorization requires a printed name, title, signature, and date from an authorized representative certifying that they have authority to execute the authorization. The vendor authorizes the State of Colorado to initiate, change, or cancel EFT transactions and to reverse any erroneous payments made in error. The authorization remains in effect until the state receives written cancellation notice with sufficient time to process the request. This form represents standard documentation necessary for vendors to receive state payments through electronic direct deposit rather than traditional check payments.