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) CTXCD+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) SignatureDateReturn to:Southwest Bank of Texas Attn: Jeanette Puerta P.O. Box 27459 Houston, TX 77227-7459 (713) 235-8881 ext. 1746Fax: 713-235-8839American LegalNet, Inc. www.USCourtForms.com
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