Fillable ELECTRONIC-PAYMENTS-2018-form City of Fresno Finance Department

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ELECTRONIC-PAYMENTS-2018-form City of Fresno Finance Department

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CITY OF FRESNO
FINANCE DEPARTMENT
ACCOUNTS PAYABLE SECTION
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH
PAYMENTS)
Company Contact Email
Name Address
(Required)
Contact Name Telephone Number
The City of Fresno, Finance Department, (FINANCE DEPARTMENT), is authorized to initiate credit entries to the
company above, (COMPANY), in the account below at the depository financial institution named below,
(DEPOSITORY), and to credit the same to such account. Company acknowledges that the origination of ACH
transactions to its account must comply with the provisions of U.S. law.
Depository
Name
Branch
City State Zip Code
Routing Account
Number Number
o ACH Authorization Agreement Form already on file with City.
This authorization is to remain in full force and effect until FINANCE DEPARTMENT has received written
notification of its termination. The FINANCE DEPARTMENT and DEPOSITORY have a reasonable time
to process the termination.
Name(s)
(Please print)
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Title
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ELECTRONIC-PAYMENTS-2018-form City of Fresno Finance Department

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Completed 12 July 2020

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