Free Electronic Funds Transfer  - Oklahoma

State of Oklahoma
Secretary of State
Electronic Funds Transfer Authorization

FROM AGENCY: Agency Number: TO PARTICIPANT: Participant/Client ID: 625

CLASS ID: Agency Name:

ACH Secretary of State

Client Account Number-Assigned by Secretary of State SoonerAccess

Name of Financial Institution: Address of Financial Institution:

Financial Institution Routing Transit Number/ABA #: Financial Institution Account Number To Be Charged: Type of Account: Checking: General Leger: Telephone: E-mail Address Work: Home: Savings:

I hereby authorize the State of Oklahoma Treasury, hereinafter called Treasury and ________________________, to deduct from the identified account the amounts due to the Oklahoma Secretary of State. This authority is to remain in full force and effect until the Oklahoma Secretary of State has received written notification by me of its termination in such time and in such manner as to afford the Oklahoma Secretary of State and the financial institution a reasonable opportunity to act on the request to terminate this agreement.

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Any amount due for business entity filings, trademarks, copy orders, notary, or other services of the Oklahoma Secretary of State will be deducted in accordance with this agreement.

Attach either a voided check, or a letter of verification from your financial institution. The letter of verification must contain the bank's ABA number (transit routing) and your bank account number. Return the completed form to: Oklahoma Secretary of State Attention: Accounting 2300 N. Lincoln Boulevard Suite 101 Oklahoma City, Oklahoma 73105-4897