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Wire ACH Enrollment Form

This document is a WIRE/ACH Request Form for credit payments to be processed by Bank of America. It requires details such as account holder information, depository institution, and bank account numbers, along with an authorization for electronic transactions. A voided check is needed if the payment is to be processed as an ACH.

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robertlee00lee
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49 views1 page

Wire ACH Enrollment Form

This document is a WIRE/ACH Request Form for credit payments to be processed by Bank of America. It requires details such as account holder information, depository institution, and bank account numbers, along with an authorization for electronic transactions. A voided check is needed if the payment is to be processed as an ACH.

Uploaded by

robertlee00lee
Copyright
© © All Rights Reserved
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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Bank of America, NA, 600 N.

Cleveland Avenue, Suite 300, Westerville, Ohio 43082


WIRE/ACH Request Form

For Credit Payments

DATE: ______________

TRANSACTION METHOD: WIRE ACH

ACCOUNT NAME

BENEFICIARY NAME: ___________________________________________________________________

Account Holder/ Business Address: _______________________________________________________

City: ________________________________State: ______________ Zip:________________

DEPOSITORY INSTITUTION:
Bank/Depository Name: ______________________________________________________________

Bank Address: ______________________________________________________________________

City: ________________________________State: ______________ Zip:________________

BANK ACCOUNT:
Bank Account #: ____________________________________________________________________

ABA#: _____________________________________________________________________________
(Must be 9 digits only)

______________________________________________________________________

Printed Name and Title:____________________________________________________________


THIS FORM IS USED TO CREDIT AN ACCOUNT FOR PAYMENT OR TO ESTABLISH RECURRING PAYMENT
CREDITS FOR THE ABOVE STATED ACCOUNT.

The following disclosure applies to any payments made to this account:


I (we) hereby authorize Bank of America, to initiate credit entries to the Bank Account designated above at the Depository Institution designated
above. I (we) acknowledge that the origination of electronic wire and/or ACH transactions to my (our) Bank Account must comply with the
provisions of U.S. law. I (we) agree to be bound by the National Automated Clearinghouse rules, as in effect from time to time. I (we) take full
responsibility for any fees imposed to process the electronic wire and/or ACH transaction by my (our) Depository Institution. If my (our) Bank
Account has changed or is closed for any reason I (we) will take the appropriate due diligence to provide Bank of America with new or revised
Bank Account information sufficient to complete electronic wire and/or ACH transactions into the new or revised bank account.

Please include a COPY OF A VOIDED CHECK only if you would like your
payment processed as an ACH
Return this document
Bank of America, NA, 600 N Cleveland Ave, Suite 300, Westerville, OH 43082

If you have questions, please call your directly

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