Leon County Sheriff's Office Vendor ACH Authorization

Leon County Sheriff's Office

Vendor ACH Authorization

This form is intended for vendors who are already registered to do business with LCSO. If you have not registered, please visit https://app.smartsheet.com/b/form/135fb87ce99b446986fbd0ad038ac4b9.

Please contact LCSO.VendorHelp@leoncountyfl.gov with any questions.

Company Name*

As listed on the W-9 form

Doing Business As (dba) name (if applicable)

Taxpayer Identification Number (TIN)*

As listed on the W-9 form.

Note: Foreign vendors should input "Foreign Vendor."

Billing Address*

Billing Contact Name*

Billing Contact Title*

Billing Contact Phone*

Phone

Billing Contact Email*

Payments

Direct deposit/ACH is now the preferred way for LCSO to make payment to our vendors. ACH is a much more secure method of payment which shortens the amount of time between payment issuance and payee receipt by days.

ACH does NOT give LCSO access to your firm's bank account. The Sheriff's bank will use this information to send payments through an ACH transmitter, where your financial institution will pick up the transaction. The Sheriff has no means to access any information about your bank account.

Financial Institution Name*

ACH Account Type*

Checking

Savings

ACH Routing Number*

ACH Account Number*

Remittance Advice/ACH Email*

Attestations

Authorized Representative*

By typing my name in the box below, I certify that I am an authorized representative of the referenced company and everything entered is true and correct.

Supporting Document Upload

Please use this to upload any documentation supporting your ACH information.

Drag and drop files here or

Send me a copy of my responses

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