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Get VT F&M Vendor ACH Authorization 2011

E TAXPAYER IDENTIFICATION NUMBER [EIN or SSN] VERMONT VENDOR ID NUMBER (if available) Section 2: Banking Information BANK NAME ADDRESS ACCOUNT NUMBER CITY STATE ROUTING NUMBER (9 digits) ZIP CODE ACCOUNT TYPE (check one) Checking Savings CHANGE Request - Previous Bank Account Number: Section 3: Vendor Authorization I authorize the State of Vermont to initiate/change/cancel ACH credit entries to the above bank account. I further authorize the State of Vermont to reverse any payment .

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