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EFT Authorization Form. This is a Texas form and can be use in Harris Local County.
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Tags: EFT Authorization, Texas Local County, Harris
EFT AUTHORIZATION
Harris County Child Support
____________________(“Company”) desires to make payments for child support payments(s) by
electronic funds transfers (“EFT”) through the automated clearing house system.
Company certifies that is has selected the following ACH format as indicate below and will begin payment
of child support garnishments once testing and approval have been given by Southwest Bank of Texas and
Harris County Child Support.
ANSI X12/NACHA Payment Format (Please Check Selection)
CTX_______CD+_______
Company Name:
_________________________________________________________
Address:
_________________________________________________________
Financial Contact:
_________________________________________________________
Phone #:
_________________________________________________________
Technical Contact:
_________________________________________________________
Phone #:
_________________________________________________________
Target Date of Implemantation: ___________________________________________________
This authority for electronic payment will remain in full force and effect until Harris County has received
notification from the undersigned (or either of them, if more than one) in such time and in such manner as to
afford Harris County and Southwest Bank of Texas a reasonable time to act on it.
________________________________________________________________
Tax I.D. number(s)_____________________
____________________________________
Signature
Return to:
Southwest Bank of Texas
Attn: Jeanette Puerta
P.O. Box 27459
Houston, TX 77227-7459
(713) 235-8881 ext. 1746
______________________
Date
Fax: 713-235-8839
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