This form is used to establish Automated Clearing House (ACH) payments. When payments are made as a result of submitting this form, funds will be automatically deposited to the account indicated. A remittance advice will be emailed to the email address shown in the "Email Address for Remittance Advices" section. The email remittance advice will contain the same information that is listed on a check stub, i.e. invoice number, invoice date and invoice amount. Failure to provide the requested accurate information may delay or prevent the receipt of payments through ACH.
For questions regarding the completion of this form, call 240-777-8850 or send an email to APSupplierMaintenance.Finance@montgomerycountymd.gov