VENDOR_DIRECT_DEPOSIT.pdf

Pam Childers Clerk of the Circuit Court and Comptroller, Escambia County Clerk of Courts • County Comptroller • Clerk of the Board of County Commissioners • Recorder • Auditor

Finance • 221 Palafox Place • Suite 140 • Pensacola, FL 32502 Telephone 850-595-4847 • vendor.services@escambiaclerk.com

Dear Vendor:

The Escambia County Clerk and Comptroller is pleased to offer the option for Escambia County Board of County Commissioners’ vendors to receive payment of invoices via ACH funds transfer. Instead of receiving a paper check through the mail, a deposit will be made directly to your authorized bank account. Going paperless is an easy way to gain efficiencies and convenience for your office including more immediate access to your cash.

There will be no more checks lost in the mail, no waiting in bank lines to deposit your check, and no waiting for the check to clear the bank. Switching from paper checks benefits the environment too.

When a payment is processed, an email will be sent from AccountsPayable@EscambiaClerk.com to the email address you provide on the ACH authorization form. The email will include an attachment of a remittance advice containing the same detailed information currently on a check stub. Please ensure that you include an email address on the authorization form, otherwise no remittance information will be sent.

To participate in the ACH payment method, an authorized officer for your company should complete and return the enclosed Vendor ACH Authorization Agreement. If you have any questions regarding this information, please email vendor.services@escambiaclerk.com or contact Donna Brewton at (850) 595-4847.

Sincerely, Pam Childers Clerk of the Circuit Court and Comptroller

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Escambia County Board of County Commissioners Vendor ACH Authorization Agreement

Upon completing this form, submit the signed original to the Clerk of Circuit Court and Comptroller, Finance Department, 221 Palafox Place, Suite 140, Pensacola, FL 32502.

If you have questions, please contact Accounts Payable at (850)595-4847.

ACH Account (Please Check One Option)

New Agreement Change to Current Agreement Cancel ACH

Vendor Information Vendor Number:

Vendor Name:

Street Address:

City, State, Zip:

e-mail for Remittance Advice:

Vendor Contact Information

Name:

e-mail Address:

Phone Number:

Financial Institution Information Account Type: Checking Name of Financial Institution :

Phone Number:

Bank Routing Number (max15 digits) :

Account Number:

Vendor Agreement: I, the undersigned, hereby authorize and request the Escambia County Clerk of Circuit Court and Comptroller's ("Clerk") Office to initiate credit entries, and if necessary, a debit entry in accordance with NACHA rule s reversing a credit entry made in error, to my account at the above-named financial institution. This ACH is to remain in effect until changed by: (a) an officer of the vendor; (b) the vendor's legal representative;

(c) the above-named financial institution; or (d) the Clerk's Office. Any change must be in writing and must be transmitted in a timely manner for any change to take effect. An ACH Remittance Advice will be emailed to my remittance email when a deposit occurs. If no email address is provided, I understand that no remittance information will be sent. The Clerk's Office will not be responsible for any loss that arises solely by reason of error, mistake, or fraud regarding information provided on this form.

Note: Please ensure you notify the Clerk's Office prior to closing your account. If a change to your bank account occurs without the Clerk's Office receiving prior written authorization, a delay of funds may occur (up to 10 business days).

Signature of Company Official Date

Printed Name Title

For Internal Clerk's Office use only:

Verified by Clerk's Accounts Payable:

Clerk's Accounts Payable