MTS Vendor ACH Enrollment form This form is used for Automated Clearing House (ACH) payments to provide payment related information to your financial institution. You must check with your financial institution to confirm funds have been deposited. Information on this form is subject to additional verification.VENDOR INFORMATION (Remit Address) New Request Change Request VENDOR NAME TAXPAYER ID (Required)(Required) ADDRESS CITY STATE ZIP ACCOUNTING CONTACT NAME TELEPHONE NUMBERFAX NUMBER (If Applicable)EMAIL ADDRESS (PRINT CLEARLY) – *Required to receive remittance. FINANCIAL INSTITUTION INFORMATION BANK NAME ADDRESS, CITY, STATE AND ZIP CODE ACCOUNT NAME ACH ROUTING NUMBER (9 Digits) ACCOUNT NUMBER ACCOUNT TYPE CHECKING SAVINGS Certification:I certify I am responsible for notifying any changes to the information provided above to MTS Transportations. I certify that I agree to immediately return any erroneous payments that may occur because of payment via ACH. I certify the information provided on this form is true and correct, and that I, as an authorized representative for the abovenamed company, hereby authorize MTS Transportations to electronically deposit payments to the designated bank account. This authority remains in full force until written notice of change or cancellation is received by MTS Transportations. MTS Transportations reserves the right to cancel or suspend this authorization at any time. Authorization:Authorized Official Name SignatureTitle Date MM slash DD slash YYYY Please email the completed form along with a VOIDED CHECK to: info@mtstransportations.com ****** A voided check is required to process this form. ******
