Orange County NC Website
Browse       Search
FINANCE AND ADMINISTRATIVE SERVICES <br /> Phone (919) 245-2450 131 W Margaret Lane, Suite 300 <br />PO Box 8181 <br />Hillsborough, NC 27278 <br />www.orangecountync.gov <br />REVISED Dec 2023 <br />VENDOR #: Munis Updated by: <br />AUTHORIZATION FOR PAYEE ELECTRONIC FUNDS TRANSFER (EFT) PAYMENTS <br />Payee Information: Payee Tax ID <br />Payee Name: <br />Payee DBA: <br />(Doing Business As, if applicable) <br />Remittance Address: <br />Remittance City: State: Zip Code: <br />Contact Name: Phone #: <br />E-Mail Address: <br />Bank Information: <br />Bank Name: <br />Bank Address: <br />Bank City: <br />Bank Account Info: <br />Routing Number Account Number <br />Account Name: <br />Account Type <br />(please check only one) Checking Savings <br />As the payee or an authorized representative of the company, authorization is herein granted to the Orange <br />County, NC to deposit funds to the bank account listed above for payments of invoices and services in lieu of <br />a printed check. Please submit the completed form and a copy of a voided check or a letter from your <br />bank providing confirmation of your account information. The County may prenote to validate the <br />account and routing details. <br />Signature of payee or authorized representative Date <br />81-0861365 <br />The Law Office of Derrick J. Hensley, PLLC <br />NC 27278 <br />401 Meadowlands Dr., Ste. 201 <br />Hillsborough <br />Derrick Hensley <br />Derrick@LODJH.com <br />9194801999 <br />Civic FCU <br />3600 Wake Forest Road, Raleigh, NC 27609 <br />Raleigh <br />253184537 4041978 <br />Civic Business Checking <br />Derrick J. Hensley Digitally signed by Derrick J. Hensley <br />Date: 2025.07.22 12:50:17 -04'00'07/22/2025 <br />Docusign Envelope ID: D93C5068-8EF6-4BC9-8D5A-4D4FF1A6FBEF