BIA Cordon Bleu - Vendor ACH Payment Authorization

ACH Payment Authorization Form

Vendor Payment Setup

BIA Cordon Bleu Banking Information

Account Name: BIA Cordon Bleu

Bank Name:

Routing Number:

Account Number:

Account Type:

Vendor Information

Vendor Company Name

Authorized Contact Name

Email Address

Phone Number

Authorization:

I hereby authorize the above-named vendor to initiate ACH credit entries to the BIA Cordon Bleu bank account listed above for payment of invoices and services rendered. This authorization will remain in effect until BIA Cordon Bleu provides written notification of its termination.

By signing below, the vendor agrees to comply with all applicable ACH rules and regulations and confirms that they have the authority to initiate payments to the specified account.

Vendor Authorization Signature

Authorized Signature

Date

Printed Name:

Title:

ACH Payment Authorization Form

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