Ach Debit Authorization Agreement PDF Details

Managing finances often involves setting up recurring transfers or payments, a process made smoother and more reliable with the use of an ACH Debit Authorization Agreement form. Particularly for BECU account holders looking to transfer funds from an account at another financial institution into their BECU account, this form is essential. It caters to various needs such as establishing a new ACH authorization, modifying the details of an existing one, or cancelling it altogether. Key sections of the form require detailed account information from both the BECU account and the account to be debited, including specifics such as account numbers and financial institution details. Additionally, it outlines the requirements for the amount to debit, not exceeding a certain limit per month, and the date or frequency of the transactions. It also emphasizes the importance of submitting the form and any necessary documentation well ahead of the intended debit date to avoid processing delays and underscores the legal compliance of such transactions. Importantly, the form includes a section for authorization, confirming the account owner's consent to the transactions and acknowledging their responsibility for providing accurate information. This form not only facilitates efficient and accurate transactions but also incorporates measures to correct errors and adjust plans as financial needs evolve.

Form NameAch Debit Authorization Agreement
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesgeneric ach debit authorization form, ach authorization to pull from my account, ach debit authorization agreement blank, ach debit agreement

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Use this form to request recurring transfer of funds from your account at another financial institution to your BECU account. Complete this form only if the other institution cannot set up the transfer.

Indicate the reason for this Debit request (check only one):

Create a new ACH authorization (Complete sections 1-4 and 6.)

Change the date/amount/bank/account number of an existing ACH authorization (Complete sections 1-4 that apply, and 6.)

Cancel an existing ACH authorization (Complete sections 5 and 6.)

1. Account Information


CURRENT BECU ACCOUNT NUMBER (if changing account used for authorizations)



2. Financial Institution to Debit






To avoid processing delays:

Requests must be received by BECU 10 business days prior to date of the debit.

You must be an account owner on both accounts.

Attach document from the other financial institution:

Must be pre-printed with the names of the account owners and the complete account number.

Acceptable documentation: voided check, statement copy, or verification letter.

3.Amount to Debit

AMOUNT TO DEBIT (Not to exceed $5,000 per month)

4. Date / Frequency

Date/Frequency. I would like my ACH transaction to begin transferring on (MM/DD/YY)



and to recur as follows:

Bi-weekly, every two weeks (indicate day) M T W TH F




Monthly (indicate date 1st-28th or last day of month)





Semi-Monthly, every 15 days (indicate dates 1st-28th or last day of month)




Note: If the date you have requested the ACH transaction to occur is on a weekend or holiday, the transaction will occur the following business day. If you are using the funds for a BECU loan payment, you must choose a date 4 days prior to your loan due date to avoid NSF fees.

5. Cancel an Existing ACH Debit Authorization

Please cancel the ACH from





(Financial Institution)


(Dollar Amount)




(Account Number)

6. Authorization

I (We) acknowledge that the origination of ACH transaction to my (our) account must comply with the provision of U.S. Law and the Rules of the National Automated Clearing House Association. I (We) further acknowledge that I (we) have retained a copy of this authorization when I (we) signed it.

You hereby authorize and request BECU to debit funds from your account at the financial institution indicated, and credit the funds according to the above instructions. Funds need to be on deposit at the designated financial institution on the evening prior to the effective date of the ACH debit. In the event of an error, you authorize BECU to take any and all action required to correct the error.

We may cancel and or terminate any EFT services at any time for any reason and without prior notice, but we may notify you after the cancelation or termination as may be required by law.

If you are using funds for a BECU loan payment, the ACH may automatically inactivate once the loan is paid off. Please notify BECU if you would like the authorization to continue. You must notify BECU in writing if you would like to make any changes or to cancel the authorization.

You agree to indemnify and hold BECU harmless from all costs, including attorney’s fees, (to the extent permitted by law), damage or claims related to BECU’s action in refusing payment of the item, including claims of any joint account -holder, payee, or endorsee, or in failing to cancel or process an item as a result of incorrect information provided by you.

By signing below, you certify that the information you have given on this ACH Debit Authorization Agreement for Direct Paymen ts is complete, true, and submitted for the purpose selected above.












BECU Use Only

If form is not submitted electronically, please return completed and signed form to:

BECU Deposit and Payment Processing M/S: 1085-2 PO Box 97050 Seattle, WA 98124 | Fax: 206-965-3236



BECU 7985 01/2020

How to Edit Ach Debit Authorization Agreement Online for Free

It's easy to fill out the authorization for ach form template document with our PDF editor. The next steps will let you quickly create your document.

Step 1: Press the orange "Get Form Now" button on the following webpage.

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The next areas are inside the PDF file you'll be filling out.

writing ach debit authorization letter part 1

Type in the demanded information in the box DateFrequency I would like my ACH, and, Please cancel the ACH from, for, effective, to BECU, Financial Institution, Dollar Amount, Date, Account Number, Authorization, and I We acknowledge that the.

stage 2 to filling out ach debit authorization letter

Remember to emphasize the vital particulars from the I We acknowledge that the, SIGNATURE, DATE, BECU Use Only, REP NAME, EXTENSION, If form is not submitted, and BECU segment.

Finishing ach debit authorization letter step 3

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