Business Name:
Bank Name:
Account Number:
Authorized Signature
STREET ADDRESS 2
CITY
STATE
ZIP
Account Owner Contact Phone
Account Owner Name
Routing Number
ACH Post Date:
Type of Account:
City First Enterprises
1342 Florida Ave NW, Washington, DC 20009 202.745.4490 info@cfenterprises.org
City First Enterprises
Payment Form
For
q
uestions in regard to filling out this form, please contact us directly at
dcgrant@cfenterpises.org
or
202-745-4485
Payment Method:
ACH/Wire
Check
For payment via ACH/Wire complete the information below:
Name on Account:
Account Address:
STREET ADDRESS 1
Savings
For payment via check
please complete the information below:
Business Name
Payee Name
Authorized Contact Name
Authorized Contact Phone
Checking
Date
Account Owner Email Address
Authorized Contact Email Address
STREET ADDRESS 2
CITY
STATE
ZIP
STREET ADDRESS 1
Business Address
Authorized Signature
Date
STREET ADDRESS 2
CITY
STATE
ZIP
STREET ADDRESS 1
Mailing Address
check here if mailing
address is the same
City First Enterprises
1342 Florida Ave NW, Washington, DC 20009 202.745.4490 info@cfenterprises.org