The City of Tallahassee

Housing Assistance Online EFT/ACH Form

In order to receive a housing assistant payment via ACH from the City, you must be set up as a City of Tallahassee Vendor. Please complete and submit this form as soon as possible. If you already have an existing vendor ID, please remit the number to the City’s Housing Division at housing@talgov.com. Please reference the program and application/participant ID.

New Vendor ACH Form (*required fields have a red asterisk)

* Entity Name 1:

Entity Name 2:

* Entity Address 1:

Entity Address 2:

* City:

* State (2-Letter Abbreviation):

* Zip Code:

* Business Contact Name:

* Business Contact Phone Number:

* Business Contact Email Address:

* Taxpayer Identification Number Type:
FEISSN

* Taxpayer Identification Number (Do not include dashes. Enter numbers only.):

* Bank Name:

* Bank Routing Number:

* Bank Account Number:

* Signature (click "Save Signature" when done signing)

By signing my full name, I am certifying that the number shown on this form is my correct taxpayer identification number and that all information contained is correct to the best of my knowledge.

* Print Name and Title: