You are here

Home » IT Systems » Accounting systems » Statewide Vendor/Payee Services » Vendor/Payee Direct Deposit

Vendor/Payee Direct Deposit

Download the Direct Deposit Authorization Form

The Direct Deposit Authorization form should be used to perform one of the following:

  • Set-Up Direct Deposit Payment
  • Modify existing Direct Deposit arrangements
  • Cancel Direct Deposit and re-instate payment through U.S. mail

PART A - Identification details:

  • You MUST provide your Statewide Vendor Number unless this form accompanies a new registration.
  • If you do not know your Statewide Vendor Number use the link provided - Statewide vendor number lookup
  • You MUST provide your legal name as it appears with the IRS.
  • Please provide your DBA if you have one.
  • You MUST provide your Social Security Number (SSN) OR Employer Identification Number (EIN). Do not provide both.

PART B - Payment option:

  • Check the box indicating your preferred method of payment.

PART C - Direct Deposit information and signature:

  • If you checked Direct Deposit in Part B, fill out all fields in Part C.
  • Please note that if the Account type is left blank we will default to checking account.
  • Please note that if Payment type is left blank, we will default to corporate/business payment.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.