Form Sco Eft-1 - Authorization Agreement For Electronic Funds Transfer - 2017

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AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFER (SCO EFT-1)
Complete Section I Below:
New ACH Registration
Change EFT Remittance Method
Please Check Appropriate Boxes
Change Holder Contact Information
HOLDER INFORMATION
-
FEDERAL EMPLOYER ID# (FEIN):
NAME
ADDRESS
CITY
STATE
ZIP
UNCLAIMED PROPERTY HOLDER TYPE
( _ _ _ ) _ _ _ - _ _ _ _
PHONE
EXT
CODE
CONTACT INFORMATION (for EFT Registration)
NAME
EMAIL
( _ _ _ ) _ _ _ - _ _ _ _
( _ _ _ ) _ _ _ - _ _ _ _
PHONE
EXT
FAX
Complete Section II, III or IV Below:
SECTION II
ACH DEBIT
I have verified our company’s Financial Institution can originate an ACH Debit transaction in the required record field.
DATE
SIGNATURE:
TITLE
SECTION III
ACH CREDIT
I have verified our company’s Financial Institution can originate an ACH Credit transaction in the required record field.
SIGNATURE:
TITLE
DATE
SECTION IV
INTERNATIONAL FUNDS TRANSFER
SIGNATURE
TITLE
DATE
For EFT assistance Call (916) 464-6220 or Email
updscoeft@sco.ca.gov
Return this completed EFT-1 Form by: Fax to (916) 464-6224, Email to
updscoeft@sco.ca.gov
or mail to
State Controller's Office, Unclaimed Property Division, Attention: EFT Desk
P.O. Box 942850, Sacramento, CA 94250-5873
Rev. 05/2017
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