Fillable Worldwide Shared Services Vendor ACH Authorization (CyberGrants)

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Worldwide Shared Services Vendor ACH Authorization (CyberGrants)

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Vendor ACH Authorization
This information below authorizes Disney Worldwide Shared Services to make ACH payments.
Vendor Information
Vendor Name: _______________________________
Vendor Address: _______________________________ City___________________State____ Zip______
Vendor Remittance Notification e-Mail address: _______________________________________________
ACH Contact Person Name: ________________________________ Phone Number: ________________
Bank Name: _____________________________________
Bank Address: ___________________________________ City______________State____ Zip___________
Bank Routing Number (ABA): ______________________
(must be 9 digits)
Vendor’s Bank Account Number: _____________________ Checking Savings
__________________________________________________ ________________________________
Signature Date
_____
______________________________________________ ________________________________
Printed Name Company Title
ACH (5/2016)
© Disney
SAP Vendor Number: _______________________
Worldwide Shared Services
Vendors/Suppliers: Completed and signed ACH forms should
be returned to your Disney representative.
Disney Proxy Requestors: Please enter the banking
information in the Disney Supplier Management Portal
(DSMP) via SAP. Upload a copy of this form in the Document
Uploads section.
The above ACH payment instructions are authorized, and the terms and conditions stated in this agreement are accepted by:
Bank Information
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Worldwide Shared Services Vendor ACH Authorization (CyberGrants)

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Completed 12 February 2021

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