Vendor Maintenance and Electronic Funds Transfer

Required fields are marked with asterisks (*)

Vendor Maintenance and Electronic Funds Transfer Form

Instructions

Indicate the Type of Authorization and complete all requested information below.
Attach a void cheque displaying the Vendor Name or a letter from the Vendor’s financial institution. Void cheque/ bank letter is required for all banking changes.
Enter the e-mail address where the Remittance Notification is to be sent to.

Note: it is advisable to use a secured generic e-mail address that will not be affected by a change of staff in the Vendor’s organization.

Type of Authorization (check one only)

Existing Vendor – New/ Updated Information

New Vendor Account Setup

Vendor Information * All

Legal Business Name:

Operating As Name (if different from above)

Remittance Address: (incl. Steet, City, Province, Postal Code)

GST/HST Number (if applicable)

Remittance Phone:

Remittance Email Address:

Remittance Contact Name:

Financial Institution * All

Name of Financial Institution:

Transit Number:

Branch Number:

Bank Account Number:

ATTACH VOID CHEQUE or BANK LETTER

Authorization

I/We authorize the Town of Wasaga Beach to make all payments by direct deposit into the above account (I/We have attached a void cheque/bank letter). I have the authority to provide the above information on behalf of the corporation/organization/payee. (* All)

First and Last Name:

Job Title:

Email:

Phone:

Signature:

Clear

Date (mm-dd-yy):

Please upload your void check/direct deposit/account/banking information here (4.0 MB max size)

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Personal information contained in this form is collected under the authority of the Municipal Act, S.O. 2001, c.25, s.11 and will be used for the purpose of depositing payments into the named Vendor’s bank account and providing payment notifications by e–mail. Questions about this collection should be directed to the Town's Accounts Payable Clerk, via email to payables@wasagabeach.com or phone at 705-429-3855 extension 2243. Form revised December 2021

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Vendor Maintenance and Electronic Funds Transfer Form

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