Required fields are marked with asterisks (*)

Electronic Funds Transfer Information

All sections marked with a red asterisk (*) are required fields.

Section A: Vendor Information

(please verify information is correct)

Vendor Name:

Vendor ID:

Mailing Address:

City/Town

Postal Code

Phone:

Email Address for Payment Remittance Advice:

Section B: Banking Information

(please complete all fields to ensure successful EFT transfer)

Branch/Transit #:

Institution #:

Account #:

Name of Financial Institution:

Branch Address:

City/Town

Branch Phone:

A copy of void cheque must be included to process payment (could be an image or pdf of scanned void cheque)

NOTE: to upload a file click the Browse... button and locate the file on your system. Once you have located and selected the file click the Open button. To upload the selected file click the Upload button

UPLOAD A copy of void cheque here:

Browse…

Allowed extensions pdf, jpg, jpeg, gif, png, tif

Section C: Company Authorization

Name:

Title:

Email:

Contact Phone:

Date:

Authorization

I authorize the County of Perth to deposit all payments to the above bank account and forward remittances to the e-mail address indicated until notified of a change

If you wish to make payments to the County of Perth electronically, details are:
Institution ID: 010 CIBC	Transit Number: 00252	Account Number: 88-48718