Authorization Agreement For Direct Deposit Of Eft Payments
Authorization contract for direct deposit of payments eft AUTORISATION AGREEMENT FOR DIRECT DEPOSITOF EFT PAYMENTSAll parties from form must be completed by the Seller. Incomplete forms are returned. The must be readable. Make sure this is the latest version form on www.ohiosharedservices.ohio.gov.SECTION 1TYPE OF TRANSACTION: ADD CHANGE/UPDATE INATENAME OF COMPANY OR INDIVIDUAL (name must match verification attached bank) ADDRESS (address must match the address indicated on the attached bank audit) CITY STATE ZIPPHONEEMAILFEDER EMPLOYER ID (EIN) OR SOCIAL SECURITY NUMBER (SSN)CHECK ALL THAT APPLY RSC – PCA ODJFS PROVIDER (PROVIDER ID NUMBER REQUIRED) WINNER LOTTERYALL OTHER:SECTION 2 – NEW FINANCIAL INFORMATION – BANK VERIFICATION MUSSNEW FINANCIAL INSTITUTION NAMEPHONETYPE OF ACCOUNT CHECKING SAVINGSNEW ACCOUNT NUMBER (account number must match attached bank audit) NEW TRANSIT ROUTING/ABA NUMBER (the routing number must match the attached bank check) Section 3 – OLD/PRIOR FINANCIAL FINANCIAL INFORMATION – MUST BE PROVIDED TO CHANGE/UPDATE ACCOUNTold/PRIOR FINANCIAL INSTITUTION NAMEPHONEOLD/PRIOR ACCOUNT NUMBER previous account numbers in the file)OBM-4310 REV. 07/08/2013 ..