ACH Deposit Authorization

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ACH Deposit Authorization

Uploaded by

Nseke Epalle

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

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ACH Authorization Form

Please print and complete ALL the information below.

Name: ____________________________________________________________

Address: ____________________________________________________________

City, State, Zip: ____________________________________________________________

Name of Bank: ____________________________________________________________

Account #: ____________________________________________________________

9-Digit Routing #: ____________________________________________________________

Type of Account:  Checking  Savings (Check One)

Attach a voided check the bank account to which funds should be deposited (if necessary) I
understand that if I do not attach a voided check, FACT will still process it however, FACT is not
responsible if the information provided is incorrect.

FACT is hereby authorized to directly deposit my payment to the account listed above.

Signature: ______________________________________________________

Date: ___________________________

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ACH Deposit Authorization

Uploaded by

ACH Deposit Authorization

Uploaded by

ACH Authorization Form

Please print and complete ALL the information below.

City, State, Zip: ____________________________________________________________

Name of Bank: ____________________________________________________________

9-Digit Routing #: ____________________________________________________________

Type of Account:  Checking  Savings (Check One)

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