Writing the ACH Transaction Authorization Form document
I hereby authorize Company Name to initiate ACH transactions to my:
- CHECKING ACCOUNT
- SAVINGS ACCOUNT
Account at the Depository named below. This authority is to remain in full force and effect until such time Company Name receives written notification of its termination, plus 30 days.
The purpose of the ACH Transaction(s) shall be for:
And shall occur on a Weekly, Bi-weekly, Monthly, Bi-Monthly or Yearly basis. ACH debits and credit amounts shall occur on a (fixed / variable) basis subject to the Terms and Conditions of the insert relevant information about what governs the amounts and conditions relevant to this ACH request.
Bank Name Branch
Transit / ABA Routing Number Bank Account Number