Fillable CITY OF TUCS FINANCE DEPARTM ENT ACH/EFT APPLICATION (City of Tucson)

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CITY OF TUCS FINANCE DEPARTM ENT ACH/EFT APPLICATION (City of Tucson)

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The CITY OF TUCS FINANCE DEPARTM ENT ACH/EFT APPLICATION (City of Tucson) form is 1 page long and contains:

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(INCLUDING STATE EMPLOYEE) INSTRUCTIONS ON REVERSE SIDE
FED
BUS ID
(11 DIGITS)
VENDOR NAME (30 CHARACTERS MAXIMUM)
ADDRESS
SECTION B: TO BE COMPLETED BY STATE EMPLOYEE ONLY (OTHER VENDOR SKIP THIS SECTION)
HOME ADDRESS
CITY
ZIP CODE
NCLUDING STATE EMPLOYEE)
D: FINANCIAL INSTITUTION C
AUTHORIZED SIGNATURE DATE
This authorization is to remain in full force and effect until the State of Missouri, Office of Administration has received written notification
reasonable oppor
tunity to act on it.
I (we) hereby cancel my/our ACH/EFT authorization.
I have reviewed the Vendor information for completeness and accur
SECTION E: MAILING INSTRUCTIONS
ECTION
G: OFFICE OF ADMINISTRATION US
SIGNATURE
CITY OF TUCS
ON
FINANCE DEPARTM
ENT
ACH/EFT APPLICATION
SECTION A: TO BE COMPLETED BY SUBMITTING VENDOR
- INSTRUCTIONS ON REVERSE SIDE
DESCRIPTION
NEW
CHANGE
CANCEL
TAXPAYER ID TYPE (CHECK ONE) TAXPAYER ID NUMBER VENDOR NUMBER
1 = FEIN 2 = SSN
VENDOR/PAYEE NAME
VENDOR ADDRESS
LEGAL NAME OF ENTITY OR INDIVIDUAL
TELEPHONE NUMBER WITH AREA CODE
CITY
STATE ZIP CODE
E-MAIL ADDRESS
VENDOR CONTACT NAME 1: PHONE NUMBER
FAX NUMBER
VENDOR CONTACT NAME 2: PHONE NUMBER
FAX NUMBER
SECTION B: TO BE COMPLETED BY SUBMITTING VENDOR
FINANCIAL INSTITUTION NAME IF CHANGE PLEASE INDICATE PREVIOUS FINANCIAL INSTITUTION NAME
FINANCIAL INSTITUTION ADDRESS FINANCIAL INSTITUTION TELEPHONE NUMBER
CITY
STATE ZIP CODE
DEPOSITOR ABA ROUTING NUMBER
IF CHANGE PLEASE INDICATE PREVIOUS ABA ROUTING NUMBER
DEPOSITOR ACCOUNT NUMBER IF CHANGE PLEASE INDICATE PREVIOUS ACCOUNT NUMBER
DEPOSITOR ACCOUNT TYPE (CHECK ONE) INCLUDED WITH APPLICATION (CHECK ONE)
SAVINGS
CHECKING
VOIDED CHECK BANK LETTER
SECTION C: VENDOR AUTHORIZATION
I hereby authorize the City of Tucson, Finance Department and the above named financial institution to initiate electronic
funds transfers (EFT) into the savings/checking account listed above.
I hereby cancel my ACH/EFT authorization.
AUTHORIZED VENDOR/REPRESENTATIVE SIGNATURE
SECTION D: VENDOR PAYMENT LOCATION
Vendor payment information may be viewed by going to www.tucsonaz.gov/vendorpay. You must have your City of Tucson
vendor number to access pa
yment information.
SECTION E: MAILING INSTRUCTIONS
Three ways to return completed form:
Mail to: City of Tucson Accounting Services, PO Box 27450, Tucson, AZ 85726-7450, ATTN: EFT Coordinator
Fax to: (520) 791-4364, ATTN: EFT Coordinator
Email
to:
T
Finance_EFT_email@tucsonaz.gov
The EFT process may take 6-8 weeks before deposits begin.
Please see reverse side for
details.
SECTION F: ACCOUNTING USE ONLY
AUTHORIZED SIGNATURE FOR EFT SET UP: DATE:
EFT ACTIVATION DATE:
BANK TEST DATE:
DATE
Clear Form
VENDOR ACH/EFT APPLICATION INSTRUCTIONS
Fill in the appropriate boxes as described below
SECTION A: TO BE COMPLETED BY SUBMITTING VENDOR
DESCRIPTION
Check the appropriate box for this submission
TAXPAYER ID TYPE
Check 1 if your taxpayer ID is a Federal Employers Identification number (FEIN) or 2 if your taxpayer ID is a Social Security Number (SSN)
TAXPAYER ID NUMBER
Enter the FEIN or SSN associated with the legal name of the entity or individual
VENDOR NUMBER
If known, enter the vendor number assigned to your business by the City of Tucson
VENDOR NAME
Enter the name of the entity or individual:
Individual - Enter your name (Last Name, First Name and Middle Initial)
Sole Proprietor - Enter name of Business
Corporation - Enter your Doing Business As (DBA) name
Other - Enter your entity's name
LEGAL ENTITY NAME
Enter Legal Name of Entity or Individual as filed with IRS:
Individual - Enter your name (Last Name, First Name and Middle Initial)
Sole Proprietor - Enter owner's name (Last Name, First Name and Middle Initial)
Corporation - Enter your name as it appears on the charter or other legal documentation as filed with the IRS
Other - Enter your entity's name as filed with the IRS
ADDRESS
Enter your mailin
g address
TELEPHONE NUMBER
Enter your telephone number with area code
CITY, STATE, ZIP CODE
Enter your city, state and zip code for the mailing address
SECTION B: TO BE COMPLETED BY SUBMITTING VENDOR
FINANCIAL
INSTITUTION NAME, ADDRESS, CITY, STATE, ZIP CODE, PHONE NUMBER
Enter information provided by your bank
NOTE: If this is a request for a "CHANGE" please provide your previous financial institution name in the space provided
DEPOSITOR ABA ROUTING NUMBER
Enter y
our financial institution's routing number
NOTE: If this is a request for a "CHANGE" please provide your previous routing number in the space provided
DEPOSITOR ACCOUNT NUMBER
Enter your account number
NOTE: If this is a request for a "CHANGE" please provide your previous account number in the space provided
DEPOSITOR ACCOUNT TYPE
Please select type of account (savings or checking)
SUPPORTING DOCUMENTATION
Voided check or bank letter is required to be attached with your application
SECTION C: VENDOR AUTHORIZATION
VENDOR AUTHORIZATION
Must be signed by the vendor or an authorized representative before application can be processed.
SECTION D: VENDOR PAYMENT LOCATION
Vendor Payment information may be viewed by going to www.tucsonaz.gov/vendorpay. You must have your City of Tucson vendor number to access payment
information.
SECTION E: MAILING INSTRUCTIONS
Three ways to return completed form:
Mail to: City of Tucson, Accounting Services, PO Box 27450, Tucson, AZ 85726-7450, ATTN: EFT Coordinator
Fax to: (520) 791-4364, ATTN: EFT Coordinator
E-mail to: Finance_EFT_email@tucsonaz.gov
The EFT process may take 6-8 weeks before deposits begin.
GENERAL INSTRUCTIONS
If all the necessary sections on this form are not completed, the application will not be processed.
ACH transactions will be effective approximately 6-8 weeks after the application is approved.
Changing Financial Institution or Depositor Account (within the same Financial Institution)
All deposits will continue to be deposited into your present account, unless notification of the change by submission of a new application with the
"CHANGE" box checked at the top of the form is received. Current banking information must be included.
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CITY OF TUCS FINANCE DEPARTM ENT ACHEFT APPLICATION (City of Tucson)

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Completed 16 July 2020

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