NEO PHILANTHROPY
PART 1: ACH Enrollment Form
Business/Account Name: _____________________________________________________________________
Choose One: New Vendor Change Existing Vendor Record
Type: Entity/Organization Individual
Tax ID Number:
Email Address: _____________________________________________________________________________
Account Type: Checking Savings Other, please describe: _________________________
Bank Name: ________________________________________________________________________________
Bank Address: ______________________________________________________________________________
Routing Number:
Bank Account Number:
Authorization
I hereby authorize NEO Philanthropy to electronically deposit any payments made by its Accounts Payable Department into the bank account specified above.
This authorization will remain in full force until NEO receives written notice of its termination in such time and manner as to afford NEO and bank named
above a reasonable opportunity to act upon it. In the event that the NEO notifies the bank that funds have been deposited to the account in error, I hereby
authorize and direct the bank to return such funds to NEO as soon as possible. In the event that for any reason the bank is unable to return said funds to NEO, I
hereby authorize NEO to recover those funds by any of the following methods: (1) deducting the amount of said funds from any future payments from NEO; (2)
demanding in writing the return of the funds, in which case I hereby agree to return such funds to NEO within two weeks of receipt of the written demand.
These remedies shall be in addition to and not in lieu of any other remedies available to NEO under law. I further agree that if such funds are not repaid to NEO,
I will be liable for all costs of collection, including reasonable attorney fees incurred by NEO in the collection of such funds, together with the maximum interest
permitted by law.
____________________________________________ ________________________________
Signature of corporate officer or individual account holder Date
______________________________________________
Print name and title of corporate officer or individual account holder
FOR NEO FINANCE USE ONLY
CLIENT ID: ENTERED BY: DATE ENTERED:
NEO PHILANTHROPY
PART : Wire Transfer Form for Foreign Vendors
Business/Account Name: _____________________________________________________________________
Choose One: New Vendor Change Existing Vendor Record
Type: Entity/Organization Individual
Email Address: _____________________________________________________________________________
Name of Correspondent US Bank: _____________________________________________________________
(if applicable, for payment made in US Dollars)
US Bank ABA or SWIFT Code
Foreign Bank Name: _________________________________________________________________________
Foreign Bank Address: _______________________________________________________________________
Foreign Bank SWIFT Code
International Bank Account Number (IBAN):
Authorization
I hereby authorize NEO Philanthropy to electronically deposit any payments made by its Accounts Payable Department into the bank account specified above.
This authorization will remain in full force until NEO receives written notice of its termination in such time and manner as to afford NEO and bank named
above a reasonable opportunity to act upon it. In the event that the NEO notifies the bank that funds have been deposited to the account in error, I hereby
authorize and direct the bank to return such funds to NEO as soon as possible. In the event that for any reason the bank is unable to return said funds to NEO, I
hereby authorize NEO to recover those funds by any of the following methods: (1) deducting the amount of said funds from any future payments from NEO; (2)
demanding in writing the return of the funds, in which case I hereby agree to return such funds to NEO within two weeks of receipt of the written demand.
These remedies shall be in addition to and not in lieu of any other remedies available to NEO under law. I further agree that if such funds are not repaid to NEO,
I will be liable for all costs of collection, including reasonable attorney fees incurred by NEO in the collection of such funds, together with the maximum interest
permitted by law.
____________________________________________ ________________________________
Signature of corporate officer or individual account holder Date
______________________________________________
Print name and title of corporate officer or individual account holder
FOR NEO FINANCE USE ONLY
CLIENT ID: ENTERED BY: DATE ENTERED:
