Vendor Set Up Form and ACH Authorization

Vendor Set-Up and EFT (ACH) Authorization

A required form for all FAB vendors
The Kettering Fairmont Athletic Boosters pay all vendors electronically to save processing time, eliminate the need to mail checks and save money. To be in compliance with our non-profit, tax exempt status, we require complete vendor information prior to payment or reimbursement. If you have been paid previously by the Fairmont Athletic Boosters and are receiving this form, it is to update our records. Thank you!
I (we)name of payee (individual or organization* authorize Kettering Fairmont Athletic Boosters to set me (us) as a vendor and electronically credit my (our) account when payment and/or reimbursement is requested from the Fairmont Athletic Boosters and, if necessary, electronically debit my (our) account to correct erroneous credits.
Payee Contact:*

First NameLast Name
Payee Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Payee Email:*
example@example.com
Payee Phone Number*

Area CodePhone Number
I (we) agree that ACH transactions I (we) authorize comply with the applicable law and that the depository financial institution account information below is correct.
Select one:*

Checking AccountSavings Account
Bank and Account Name*

Bank NamePayee Name as it Appears on the Bank Account
Account Information*

Routing NumberAccount Number
The payee/organization is:*

Individual / Sole ProprietorCorporationLLCPartnership/Limited PartnershipJoint VentureNon-Profit
Taxpayer ID Number or SSN:*
Enter the individual's SSN or the organization's FEIN.
I (we) understand that this authorization will remain in full force and effect until I (we) notify the Kettering Fairmont Athletic Boosters by email (fab.treasurer@ketteringschools.org) that I (we) wish to revoke this authorization.

It is important that if you change banks you notify Kettering Fairmont Athletic Boosters before you request a payment or reimbursement. There is a fee from the bank if the ACH is attempted on a closed account.
Signature of Payee or Payee Representative:*

Clear
After completing this form, click SUBMIT. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam. If you have questions email fab.treasurer@ketteringschools.org.
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Vendor Set-Up and EFT (ACH) Authorization