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
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.
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.
The undersigned is duly authorized to sign this Agreement.
AGREED AND ACCEPTED:
Name Printed Clearly Phone Number
Title Vendor E-mail address