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2. Name of Bank/Financial Institution*
4. Address1*
6. Address2
8. City*
9. State*
11. Zip*
13. Phone Number of Bank*
15. ABA # (9 digit routing #)*
16. Account #*
18. Vendor Information
20. Name of Company/Payee*
22. Email Address (required for transfer notices)*
23. Phone Number*
25. Signature*

    1. I Agree

    By selecting "I Agree" you are authorizing the City of North Richland Hills to make ACH payments using the information provided. You are also confirming that you are a representative authorized to submit this information and make these decisions on behalf of said company.
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

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