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Vendor EFT/ACH Payment Application Please print or type Company Name: Mailing Address: Contact Person: Title: Phone Number: E-mail Address: Financial Institution: Bank Routing Number: Bank Account Checking or On behalf of the above named company, we wish to participate in the City of Lewiston’s EFT/ACH accounts payable program. We understand that we need to notify the City 30 days in advance of changing our financial institution information. By signing this application below, I certify the validity of the information provided and have the authority to enroll in this program. Name Title Date