Supplier Direct Deposit

Instructions

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 by check 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.
• Your bank’s name is required.
• Enter the routing number. This is a required field.
• Enter the bank account number. This is a required field.
• 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.

Direct Deposit signature:

Please sign with a pen (an “ink signature”).

• Electronic, inserted or stamped signatures will not be accepted.
• This form is not considered valid unless it is signed

Submitting the Direct Deposit Authorization form:

Please PRINT and SIGN the completed form

SCAN to PDF format and EMAIL to: supplierforms@ofm.wa.gov

FAX to: (360) 664-3363 OR

MAIL to: Statewide Registration, PO Box 41450, Olympia, WA 98504-1450.

For questions about the form, please contact Statewide Registration at (360) 407-8180.

For any other questions, please contact the agency you are expecting payment from.