EFT Auth Form

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           THE COMPUTER MERCHANT, LTD                                                                    For TCML Use Only
           95 Longwater Circle, Norwell, MA 02061  Tel: 781-878-1070  800-617-6172                           Vendor Number
           www.TCML.com  FAX: 339-613-3022  E-Mail: Supplierservices@tcml.com
                                                                                                            Bank Acct Number
                                                                                                           Bank Account Name




                                         EFT AUTHORIZATION AGREEMENT FORM
                                                             (Electronic Funds Transfer)

Check appropriate box below                                                                                                  Please print in ink or type

   Initial                          Decline                           Cancel                          Change of                      Change of
Participation                    Participation                     Participation                   Financial Institution          Account Number

Instructions:

1.   Complete and sign The Computer Merchant LTD EFT Agreement Form.
2.   Include a copy of a voided check or deposit slip and verify with your bank that the ABA NUMBER (usually the first 9 digits at the
     bottom of your check) and your ACCOUNT NUMBER are appropriate for direct deposit purposes.
3.   Business accounts require all bank signatures necessary to be on this form. If additional lines are needed, please attach additional sheet.
4.   If you have any questions, please call Supplier Services at 800-617-6172.

I hereby authorize The Computer Merchant Limited, hereinafter referred to as “the Company,” to initiate Electric Funds Transfer
(EFT) for the purposes contemplated, herein also referred to as ACH, credit entries, or debit corrections, of all amounts payable
to me through the Company’s EFT program(s), and to the depository institution and account, identified below.


VENDOR NAME:
VOUCHER REMITTANCE E-MAIL ADDRESS:
        **The detail for the electronic remittance will be sent to the representative listed on the e-mail address above**

VENDOR REMITTANCE ADDRESS:
CITY:                                                                STATE:                                        ZIP:
FINANCIAL INSTITUTION NAME:
NAME ON ACCOUNT:
BRANCH LOCATION ADDRESS:
CITY:                                                                STATE:                                        ZIP:
BANK ABA:                                                                         ACCOUNT NUMBER:
BANK BRANCH CODE:                                                                 BANK SWIFT ID (if exists):
TYPE OF ACCOUNT:                                             Checking                                               Savings


                         This Authorization is to remain in full force and effect until the Company has received proper written
     Voided              notification from me of its change or termination, or the Company terminates its EFT Program or my
     Check               participation therein.
      Here
                         The undersigned is duly authorized to sign this Agreement.

AGREED AND ACCEPTED:


Signature                                                                         Date

Name Printed Clearly                                                              Phone Number

Title                                                                             Vendor E-mail address

				
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posted:9/17/2012
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