ELECTRONIC FUNDS TRANSFER AUTHORIZATION AGREEMENT
VENDOR INFORMATION
VENDOR NAME (“VENDOR”) CONOCOPHILLIPS VENDOR NUMBER
REMIT TO ADDRESS CITY STATE ZIP
ACCOUNTI NG / EFT CONTACT NAME
TELEPHONE FAX NUMBER
Above named Vendor hereby authorizes ConocoPhillips Company and subsidiaries of ConocoPhillips Company (collectively,
“ConocoPhillips”) to originate Automated Clearing House electronic funds transfer (EFT) credit entries to Vendor's account, as
indicated below, for payment of goods and/or services.
BANKING INFORMATION
BANK NAME BANK ROUTING NUMBER BANK ACCOUNT NUMBER
ADDRESS
PHONE BANK ACCOUNT TYPE
CHECKING _______ SAVINGS _______
CITY
STATE
ZIP BANK CONTACT NAME
Vendor acknowledges and agrees that the terms and conditions of all agreements with ConocoPhillips concerning the method and
timing of payments for goods and services shall be amended as provided herein. Vendors whose previous payments were remitted
via check will receive funds via ACH three (3) calendar days after due date on invoice. If payment date falls on a weekend or
holiday, funds will be deposited the following business day.
Vendor shall be responsible for any loss which may arise by reason of any error, mistake or fraud regarding the information
Vendor has provided in this agreement.
Vendor may change any portion of the information provided under Bank Information by giving at least thirty (30) days written
notice to ConocoPhillips at the address shown below.
This authority shall remain in effect until fifteen (15) days after Financial Institution, at address shown above, and ConocoPhillips,
at address shown below, have received written cancellation from Vendor. Notice of cancellation shall in no way affect credit or
debit entries initiated prior to actual receipt and processing of notice. Vendor understands that ConocoPhillips may suspend this
Agreement at any time.
By signing this Authorization, Vendor in no way relinquishes any legal right to dispute any item.
Vendor Authorization:
________________________ ________________________ ________________________ _______________
Authorized Name Authorized Signature Title Date
For ConocoPhillips Internal Use
Date: Time: Contact Name: Title:
Contact’s Phone Number: Contact’s Email Address:
Contact Attempts: Bank Detail Change: Payment Method Change:
Email Sent: Email Received: User ID:
Digital Signature Acceptable
Please return this form along with a voided check (if applicable) to your ConocoPhillips representative below:
ConocoPhillips Company
Attn: Vendor Master Group
440 POB
Bartlesville, OK 74004
Or RightFax: 918-662-3404
OR
Money
MKT ______
E-MAIL ADDRESS FOR REMITTANCE ADVICE (CCD OPTION ONLY):
IRS TAX PAYER ID (FEIN)
NACHA PAYMENT FORMAT (PLEASE CHECK SELECTION):
CTX ____ (No payment advice from ConocoPhillips) CCD
____ (Payment advice from ConocoPhillips) CTX FORMAT
TRANSMITS REMITTANCE DETAIL VIA EDI, CCD DOES NOT
