(Supplier Company Letterhead) Electronic Funds Transfer Authorization To Be Completed by Supplier (Please Type): Supplier Name: EFT Contact Person: Supplier Address: EFT Contact Phone Number: City: EFT Contact E-Mail Address: State: Zip: Type: Initial Electronic Funds Transfer Authorization Change in Electronic Funds Transfer Authorization Supplier Bank Account Information (Completed by Supplier): Name of Bank Bank Account Number City of Bank Bank Transit Number (9 digits) State of Bank By signing below the Supplier agrees to participate in the GHSP Electronic Funds Transfer payment program. The supplier also authorizes that future payments to their company should be made according to the Supplier Bank Account Information supplied above. ____________________________________ Financial Officer's Signature (Date) ____________________________________ Financial Officer's Name (Please Print) ____________________________________ Title Bank Verification (Completed by Supplier's Bank): The Bank Account Information as documented above by the supplier is correct for the Supplier Name referenced above. ____________________________________ ____________________________________ Bank Officer's Signature (Date) Title ____________________________________ ( )- - Bank Officer's Name (Please Print) Phone Number Mail Completed Form to: Under the GHSP Electronic Funds Transfer program, GHSP will GHSP, Inc. direct its bank to deposit payments generated weekly according Accounts Payable to the payment terms on the GHSP purchase order on the 1250 South Beechtree St. following Monday. In the event Monday is not a business day for Grand Haven, MI 49417 the bank, the deposit will be made on the following business day of the bank.