Generic Ach Debit Authorization Form Details

Ach debit authorization agreement is a contract between the merchant and the customer. It allows customers to authorize transactions that are processed through ACH electronic payment system. These agreements have been written into law by the Electronic Fund Transfer Act of 1978, which requires banks, credit unions, and other financial institutions to provide these contracts on request for any consumer who has an account with them. The article discusses how this contract may protect both parties from fraudulent transactions. Ach Debit Authorization Agreements are only valid if they are properly executed by all parties involved in the transaction - if not executed correctly then it is voidable at will by either party without recourse of damages or liability for breach of warranty.

We've compiled some useful facts about the ach debit authorization agreement. It's advised that you check out this info before you decide to start working with the PDF.

QuestionAnswer
Form NameAch Debit Authorization Agreement
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesach debit authorization agreement blank, sample ach debit authorization form, direct debit authorization form, ach debit authorization form

Form Preview Example

ACH Debit Authorization Agreement

AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS)

 

Company Name Optimist International

 

(herein referred to as “Company”)

 

 

 

 

 

 

 

 

Address

4494 Lindell Blvd. , St. Louis, MO 63108

 

 

Company ID Number

 

43-0443279

 

 

 

 

 

 

I (we) hereby authorize Company to initiate debit entries to my (our)

 

______ Checking Account

 

 

 

 

 

______ Savings Account

(select one)

 

 

 

 

Please debit my (our) account for: (select one or more)

 

______ Dues & Fees

______ CRA Adds

______ Life Members ______ Purchases

______ All Charges

indicated below at the depository financial institution named below, hereinafter called DEPOSITORY, and to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.

Depository

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

Branch

 

 

 

City

 

State

 

 

 

Zip

 

 

 

Routing

 

Account

 

 

Number

 

 

Number

 

 

 

This authorization is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

Depositor Name

 

 

 

 

Club #_____________

Signature

 

 

Date

 

Name & Title

 

 

 

 

 

 

Signature

 

 

Date

 

Name & Title

NOTE: ALL WRITTEN DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY

NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION.

Account holder is required to verify bank account data and attach a voided check here.

OI US Debit Authorization-template-112503.doc

12/16/03

 

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