ACH Authorization Agreement and Enrollment for Direct Deposit and Remittance Advice

ACH Authorization Agreement and Enrollment for Direct Deposit and Remittance Advice
University of South Carolina Educational Foundation

1027 Barnwell Street Columbia, SC 29208
Please complete this form in order to validate U.S. account information. If you have questions or need assistance with this form, please call the Foundations office at (803) 777-1466 or email EdFndAP@mailbox.sc.edu. Please do not fax.

Do not complete this form if your bank account is located outside the United States or its territories.
Vendor Type*

Individual Person (uses a Social Security Number)Corporation, LLC, Non-Profit, or other Organization (uses an Employer Identification Number)
Are you a USC employee?*

YesNo
Vendor First Name, or Full Business/Org Name*
Vendor Last Name*
Vendor TIN
Vendor Address*

Street Address

Street Address Line 2

CityState

ZIP CodeCountry
Is this a NEW ADDRESS for an existing vendor?*

Yes, this address is different than my prior submission(s)No, OR this is my first ever submission of this form
Vendor Contact Email*
Note: Payment advices with invoice numbers etc. will be sent to this email
Banking information is for bank accounts domiciled in the United States and its territories ONLY. If your bank account is outside the U.S., then please request more information from your USC sponsor and do not submit this form. Note we can only make payments in USD currency.
Bank/Financial Institution Name*
Type of Account*

CheckingSavings
ACH Routing - 9 Digits*
First two digits MUST be from 01 to 12 OR from 21 to 32. Do NOT use a deposit slip.
Account Number*
Vendor Entity Type
Vendor Social Security #/TIN*
US tax IDs only. Enter all 0s for non-US entities. USC employees may enter all 0s.
Attach Vendor's W9 or W8-BEN-E:

Browse Files
*REQUIRED* except for USC employees Cancelof
By signing this form, I authorize the University of South Carolina Foundations to initiate electronic credit entries to a checking or a savings account indicated at the financial institution identified above. I understand that payments and reimbursements may be made by the University of South Carolina Foundations, to me or the vendor I represent and only to the one bank account indicated. In the event of overpayment to this bank account, I authorize the University of South Carolina Foundations to make an adjusting debit entry to the account up to the amount of the overpayment. I may revoke or cancel this authorization and enrollment by notifying the University of South Carolina Foundations in writing at least fifteen (15) days prior to termination. Any change to the bank account or to a new financial institution will require a new ACH Authorization and Enrollment Form. Failure to notify the University of South Carolina Foundations of an account change will delay payment.
Signature of Authorized Individual*

Clear
Signature Date*

MonthDayYear
Date
Type Individual's Name *
Telephone Number

Area CodePhone Number
Should be Empty:

ACH Authorization Agreement and Enrollment for Direct Deposit and Remittance Advice

University of South Carolina Educational Foundation