Vendor EFT (Electronic Payment) Authorization Form

Vendor EFT (Electronic Payment) Authorization Form
This Vendor EFT Agreement is entered into by and between North Texas Soccer Association (NTSSA) and the undersigned vendor as of the date of the Vendor’s signature below. This Agreement sets forth the terms and conditions under which the Vendor agrees to receive payments via Electronic Funds Transfer ("EFT").
Vendor Name*

First NameMiddle NameLast Name
Vendor Cell Phone Number*
Vendor Email*
Last 4 digits of Social Security or EIN*
(this is to make sure payment goes to correct vendor)
Name on Bank Account*
Type of Account*

CheckingSavings
Bank Address*

Street Address

Street Address

CityState

Zip Code
Bank Name*
Routing Number*
Account Number*
Signature*
Date & Time*
Should be Empty: