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Free 3636A Michigan Template in PDF

The Michigan Department of Treasury 3636A form is an Electronic Funds Transfer (Direct Deposit) Authorization used for vendor payments. This form, issued under Public Act 94 of 1979, allows vendors to authorize the State of Michigan to deposit payments directly into their bank accounts. Completing this form is voluntary and can streamline the payment process for vendors.

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The 3636A Michigan form serves as a critical tool for vendors seeking to streamline their payment processes through electronic funds transfers (EFT). Issued by the Michigan Department of Treasury, this form facilitates the authorization of direct deposits into designated financial accounts, ensuring that vendors receive payments efficiently and securely. Vendors may utilize the form to initiate a new authorization, modify existing banking information, or cancel a prior authorization. Each option requires specific steps, such as entering banking details on the C&PE website prior to submitting the form for new or changed authorizations. The form also outlines necessary payee information, including taxpayer identification numbers and contact details, which are essential for processing payments. By signing this document, vendors grant the State of Michigan permission to deposit funds electronically and to rectify any errors that may occur in the payment process. It is important to note that the authorization remains valid until it is canceled by the payee or the State, and compliance with relevant rules and regulations is expected. The proper completion and submission of the 3636A form can significantly enhance the efficiency of financial transactions between vendors and the state, reducing the reliance on traditional payment methods.

Form Example

Michigan Department of Treasury 3636A (Rev. 3-08)

STATE OF MICHIGAN

Electronic Funds Transfer (Direct Deposit)

Authorization for Vendor Payments

Issued under P.A. 94 of 1979. Filing is voluntary.

Type of authorization (select one only)

NEW: Enter all banking information on the C&PE Web site before completing and submitting this form.

CHANGE: Enter all bank related changes on the C&PE Web site first. Then complete this form by entering changes to the financial institution, account number, or type of account; and submit the completed form. Do not close your old bank account until electronic payments are received in your new account.

CANCELLATION (Revocation): You may cancel (revoke) your prior Authorization by either inactivating your EFT authorization on the C&PE Web site or by checking this box and completing and submitting this form.

Mail completed form to: State of Michigan, Department of Management & Budget, Office of Financial Management, P.O. Box 30026, Lansing, MI 48909-0710 or fax the form to (517) 373-6458. If you have any questions, contact the Office of Financial Management, at (517) 373-4111 or (888) 734-9749.

Please print or type.

The number below is:

Individual Taxpayer ID No. (ITIN)

PAYEE INFORMATION

Social Security No. (SSN)

Federal Employer ID No. (FEIN)

Payee Name

SSN, FEIN or ITIN

Mailing Address (Street or RR#)

City, State, ZIP Code

Name and Title of Contact Person

E-mail Address

7. Daytime Telephone Number

Financial Institution Name

Routing Transit Number

10. Financial Institution Telephone Number

11. Account Holder's Name(s)

12. Account Number for Deposit of Electronic Funds Transfer

13. Account Type (Select one only)

14. Account Indicator

Checking

Savings

Consumer

Commercial

I authorize the State of Michigan to deposit payments owed to me by the State, by electronic funds transfer into the designated financial institution and account number. I also authorize the State of Michigan to make corrections from this account in the event that a deposit from the State of Michigan is made in error. Further, I agree not to hold the State of Michigan responsible for any delay or loss of funds due to incorrect information I have supplied on this authorization form. I understand this authorization remains in effect until cancellation: (a) in writing by the Payee or Payee's Authorized Signatory, (b) by the State of Michigan, or (c) by accessing your State of Michigan vendor record on the C&PE Web site and cancelling electronically.

I consent to and agree to comply with the National Automated Clearing House Association Rules and Regulations and the State of Michigan's rules about electronic funds transfers as they exist on the date of my signature on this form or as subsequently adopted, amended or repealed. Michigan law governs electronic funds transactions authorized by this agreement in all respects except as otherwise superseded by federal law.

If more than one signature is required to authorize withdrawal of funds, all must sign this form. Attach a page with additional signatures, if necessary.

15.	Print or Type Name of Payee or Payee's Authorized Signatory	16.	Title of Authorized Signatory

17.	Signature of Payee or Payee's Authorized Signatory	18.	Date

19.	Signature of Secondary Signatory(s)	20.	Date

▼ 3636A Michigan PDF Form

Document Specs

Fact Name	Detail
Form Title	The form is titled "Electronic Funds Transfer (Direct Deposit) Authorization for Vendor Payments."
Governing Law	This form is issued under Public Act 94 of 1979, which governs electronic funds transfers in Michigan.
Filing Status	Filing this form is voluntary for vendors wishing to receive payments electronically.
Authorization Types	Three types of authorization can be selected: New, Change, or Cancellation (Revocation).
Submission Methods	The completed form can be mailed or faxed to the State of Michigan's Department of Management & Budget.
Contact Information	For questions, vendors can contact the Office of Financial Management at either (517) 373-4111 or (888) 734-9749.
Account Types	Vendors can select either a Checking or Savings account for electronic deposits.

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