Electronic Payment Authorization Form

This form is intended for use by existing CNDC vendors to update their payment information. If you are a NEW vendor being paid by CNDC for the first time, please click here.

Name of the CNDC Project you are working for:

Name on the bank account CNDC will be depositing into: *

Name of the bank where the account is held: *

9-Digit Routing /Transit Number: *

Account Number: *

Account Type *

Checking Account

Savings Account

Authorization Type *

New Payment Set Up

Change

Are you a(n) *

Individual

Business

For verification, please provide the following information for the electronic payment authorization CNDC currently has on file:

Bank Name: *

9-Digit Routing /Transit Number: *

Account Number: *

To help ensure timely payment, and to allow CNDC to verify the information entered above, please attach a photo of a check or deposit slip.

Name of Individual Authorizing Payment: *

Your Name: *

Email address we should contact with questions: *

Signature of Individual Authorizing Payment *

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