Electronic Fund Transfer

Electronic Fund Transfer/ACH Form

Please type in information and return the completed form to Woods Hole Oceanograhic Institution. Scan to procurement@whoi.edu or Fax to (508) 457-2192.

Vendor Name:
*Contact Person:		Title:
Address:
City:
State:		Zip Code:
Phone:	- -	Fax:	- -
*Email:
*Contact name and email are required in order to receive remittance advice. I hereby authorize and request the Woods Hole Oceanographic Institution to initiate credit entries for vendor payments to the account indicated below, and the depository named below is authorized to credit such account.
Bank Name:
Bank Routing Number:		Vendor Account Number:
Account: Checking Savings

Authorization (print): ________________________________ Title (print): ______________________________

Authorization Signature on Account: ______________________________________ Date: _____/_____/_____

MS#1 • Woods Hole, MA 02543 • 508.289.2371 • Fax 508.457.2192 • procurement@whoi.edu

Last updated: June 11, 2013

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