ACH Vendor Payment Form
If you are a current DIR contracted vendor and would like to sign up for automatic transfers of Admin Fee payments, please complete the ACH Authorization form. Complete and submit the following Admin Fee Payment Remittance Form with each monthly payment.
Download ACH Authorization Form – DOC (59 KB)
Download Admin Fee Payment Remittance Form - DOCX (38 KB)
Complete the form and email to
firstname.lastname@example.org. You will be contacted with an account number within three (3) business days.
If you have any questions, please send an email to
Information about file formats