Bellevue School District. Electronic Funds Transfer Authorization
Bellevue School District makes payments to its vendors/suppliers via check or Electronic Funds Transfer (EFT) through the Automated Clearing House (ACH).
Such payments are made directly to a vendor’s account at its depository institution. Bellevue School District does not charge vendors for making payments
via EFT. This payment method can reduce preparation and handling costs to both the originator and receiver of the payment and expedite timely payments.
If you are interested in receiving payments via EFT, please read the authorization agreement and follow the instructions below.
1. COMPLETE THE FORM BELOW. Be sure to include your signature(s) and date. Please print clearly. (An incomplete form cannot be processed).
2. Verify the account and ABA/Routing number with your Bank
3. Return the completed form to: Accounting@bsd405.org or mail to
Bellevue School District
PO Box 90010
Bellevue, WA 98009
EFT AUTHORIZATION AGREEMENT
On behalf of the person identified below (whether an individual or entity, the “Vendor”), I hereby authorize Bellevue School District to make payments due
to us by initiating credit entries and necessary adjustments related to those credit entries (i.e., credit memos issued by Vendor) to Vendor’s account
identified below. I shall inform Bellevue School District by submitting a newly executed EFT authorization agreement immediately if any change occurs to
the information provided below. This authorization will remain in effect until Bellevue School District has received written notice from Vendor terminating
the authorization and Bellevue School District has had a reasonable opportunity to act (which shall not be less than 15 days) on such notice of termination.
Vendor may give notice to terminate a previous authorization by submitting a newly executed version of this form after checking the appropriate box below.
Purpose of this form (select one):
☐Provide an authorization and account information for a new Vendor;
☐Provide an authorization and account information for an existing Vendor, or
☐Terminate a previous authorization for an existing Vendor without providing new account information .
Type of account (select one): ☐ Checking Account ☐Savings Account
VENDOR INFORMATION (please print clearly)
BUSINESS NAME or DBA (if different than Legal Name)
TAXPAYER IDENTIFICATION NUMBER (TIN) TAXPAYER IDENTIFICATION TYPE
Employer ID No. (EIN) Individual Taxpayer ID No. (ITIN)
Social Security No. (SSN) N/A (Non-United States Business
EMAIL ADDRESS REQUIRED FOR PAYMENT ADVICE NOTIFICATION
NAME OF DEPOSITORY