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.
For agency-specific vendors
- Definitions of vendor types
- Statewide vendor number lookup
- Payee Registration useful information
- Vendor/payee registration form (PDF)
- Vendor/payee change form (PDF)
- Direct Deposit Authorization form (PDF)
- Account Payable Contact List