CDOT Form 1434 "General Authorization Agreement for Automatic Deposits (Ach Credits)" - Colorado

What Is CDOT Form 1434?

This is a legal form that was released by the Colorado Department of Transportation - a government authority operating within Colorado. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2019;
  • The latest edition provided by the Colorado Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of CDOT Form 1434 by clicking the link below or browse more documents and templates provided by the Colorado Department of Transportation.

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Download CDOT Form 1434 "General Authorization Agreement for Automatic Deposits (Ach Credits)" - Colorado

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COLORADO DEPARTMENT OF TRANSPORTATION
GENERAL AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS
(ACH CREDITS)
Purpose: Used to establish or update the vendor account banking information and email notification of CDOT ACH credit payments.
SSN or FEDERAL EIN:
Name:
City, State, Zip:
Address 1:
City, State, Zip:
Address 2:
Remit Email Address:
(Remittance for each payment will be emailed to this address)
Financial Institution
Name:
City, State, Zip:
Address:
Financial Institution Routing Number:
Financial Institution Account Number:
Checking
Savings
(Attach Voided Check or Bank Letter)
(Attach Bank Letter)
I (We) hereby authorize the Department of Transportation, State of Colorado, herein after called STATE, to initiate credit entries,
and if necessary, reverse any incorrect ACH credit entries made in error to our bank account indicated on this form, in accordance
with NACHA rules.
This agreement is to remain in full force and effect until the STATE has received written notification from the PAYEE of its termination
in such time and manner to afford STATE and FINANCIAL INSTITUTION a reasonable opportunity to act on it. It is the responsibility
of the PAYEE to fill out a new agreement if the PAYEE changes banks or accounts.
Authorized Signature:
Date:
Printed Name:
Title:
Email Address:
Phone Number:
CDOT Form #1434 04/19
CDOT Contact Phone No.: 303-757-9534
Please email the completed form and necessary attachments to:
DOT_Accounts_Payable@state.co.us
COLORADO DEPARTMENT OF TRANSPORTATION
GENERAL AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS
(ACH CREDITS)
Purpose: Used to establish or update the vendor account banking information and email notification of CDOT ACH credit payments.
SSN or FEDERAL EIN:
Name:
City, State, Zip:
Address 1:
City, State, Zip:
Address 2:
Remit Email Address:
(Remittance for each payment will be emailed to this address)
Financial Institution
Name:
City, State, Zip:
Address:
Financial Institution Routing Number:
Financial Institution Account Number:
Checking
Savings
(Attach Voided Check or Bank Letter)
(Attach Bank Letter)
I (We) hereby authorize the Department of Transportation, State of Colorado, herein after called STATE, to initiate credit entries,
and if necessary, reverse any incorrect ACH credit entries made in error to our bank account indicated on this form, in accordance
with NACHA rules.
This agreement is to remain in full force and effect until the STATE has received written notification from the PAYEE of its termination
in such time and manner to afford STATE and FINANCIAL INSTITUTION a reasonable opportunity to act on it. It is the responsibility
of the PAYEE to fill out a new agreement if the PAYEE changes banks or accounts.
Authorized Signature:
Date:
Printed Name:
Title:
Email Address:
Phone Number:
CDOT Form #1434 04/19
CDOT Contact Phone No.: 303-757-9534
Please email the completed form and necessary attachments to:
DOT_Accounts_Payable@state.co.us