ACH Debit Authorization Agreement PDF Details

The ACH Debit Authorization Agreement is used by BECU account holders who need to pull funds from an external financial institution into their BECU account. Because the originating institution cannot set up the transfer on behalf of the BECU member, the account holder completes this authorization directly.

Key information required on the form:

NACHA rules require that ACH debit authorizations be retained for at least two years after revocation or the last successful debit. If an unauthorized transaction occurs, you have 60 days from the bank statement date to dispute it under Regulation E of the Electronic Fund Transfer Act.

For related authorization documents, see the ACH authorization form for general bank-to-bank electronic transfers, or the ACH debit authorization form for a simplified single-debit version.

QuestionAnswer
Form NameAch Debit Authorization Agreement
Form Length1 pages
Fillable?No
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

Form Preview Example

ACH DEBIT AUTHORIZATION AGREEMENT

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

BECU ACCOUNT NUMBER (required)

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

☐CHECKING

☐SAVINGS

2. Financial Institution to Debit

NAME OF FINANCIAL INSTITUTION TO DEBIT

ROUTING NUMBER

ACCOUNT NUMBER

☐CHECKING

☐SAVINGS

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)

 

and

.

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

for

effective

to BECU

 

(Financial Institution)

 

(Dollar Amount)

 

(Date)

 

(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.

PRINT NAME

 

SIGNATURE

DATE

 

 

 

 

 

REP NAME

EXTENSION

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

Reset

 

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.

Step 2: You are now equipped to change authorization for ach form template. You've got plenty of options thanks to our multifunctional toolbar - you'll be able to add, erase, or alter the content, highlight the particular parts, and undertake other commands.

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

Step 3: Click the "Done" button. Next, you can export your PDF document - save it to your electronic device or send it via electronic mail.

Step 4: Generate copies of the form - it can help you avoid potential future problems. And fear not - we do not reveal or view the information you have.

Common mistakes to avoid on this form

  • Wrong routing number: Use the routing number for the external account being debited, not the BECU routing number. Verify it from a voided check or your bank's official website.
  • Incomplete action section: Mark clearly whether you are creating, modifying, or canceling the authorization. Leaving this blank causes processing delays.
  • Late submission: BECU needs the completed form at least five business days before the intended debit date. Submitting late may push the first transfer back by a full billing cycle.
  • Missing signature: The authorization is not valid without the account holder's signature in the designated field.

Related authorization forms

FormsPal offers several related documents for managing electronic payments. The ACH authorization form covers standard electronic fund transfers between any two bank accounts. For recurring card billing, use the recurring credit card authorization form. If you are setting up direct deposits rather than debits, the direct deposit authorization form may apply to your situation.

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