ACH Direct Deposit Authorization
Contact:
Account holder
Name:
Address:
Bank account
Bank name:
Routing number (9 digits):
Account number:
Account type: ☐ Checking☐ Savings
Authorization
I authorise to deposit payments due to me by ACH credit into the account identified above, and the bank named above to accept those deposits.
I understand a zero-dollar prenotification entry may be sent first to confirm the account details, and that it moves no money. This authorization stays in force until I cancel it in writing to the contact above, or until my employment or supplier relationship ends.
I confirm the account details above are correct and that I am authorised to act on this account.
Signature
Signature:
Printed name:
Date:
Retain this authorization for at least two years after it ends.