ACH/ Direct Deposit Payment Enrollment form
As part of our continuing efforts to efficiently process our vendor payments, York Risk Services Group, Inc. is pleased to announce the implementation of ACH (Automated Clearing House) invoice payments for all vendors.

Please complete the questionnaire below to facilitate ACH/ Direct Deposit payments to your company. All information on the form is required. Notification of each ACH payment (with remittance detail) will be sent to the email address provided on the ACH Enrollment Form.

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Email *
Contact person/title:
Telephone:
Company Tax ID/EIN: *
This is the tax ID/EIN provided to you by IRS. Don't include any dashes. It must be 9 digits, please include any starting zeros.
Company Legal Name (IRS Name): *
Company DBA Name:
Please submit a current W9 form *
I would like to get paid by ACH/Direct Deposit. *
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