Printable Ach Form Details

The Ach Payment Enrollment Form is a document that allows you to create an account for the ACH payment with your bank. This form will need to be completed by all parties involved in the transaction, including the merchant and customer. Once everything is filled out on this form it can be sent off to your financial institution, who will then create an account for you. The most common reason people would use this form is if they are accepting payments via credit card or debit card, but do not have enough funds in their business checking account when they receive an incoming deposit from the merchant. Another example is if someone needs money immediately deposited into their personal checking account without waiting 2-3 days for a check to arrive in the mail.

This quick guide will allow you to determine the time it will take you to complete ach payment enrollment form, how many pages it's got, and a few other unique specifics of the file.

QuestionAnswer
Form NameAch Payment Enrollment Form
Form Length2 pages
Fillable?Yes
Fillable fields30
Avg. time to fill out6 min 34 sec
Other namesdownloadable printable blank ach form, ach wire instructions template, printable blank ach form, blank ach authorization form

Form Preview Example

ACH VENDOR/MISCELLANEOUS PAYMENT

ENROLLMENT FORM

OMB No. 1510-0056

This form is used for Automated Clearing House (ACH) payments with an addendum record that contains payment-related information processed through the Vendor Express Program. Recipients of these payments should bring this information to the attention of their financial institution when presenting this form for completion. See reverse for additional instructions.

PRIVACY ACT STATEMENT

The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR

210.This information will be used by the Treasury Department to transmit payment data, by electronic means to vendor's financial institution. Failure to provide the requested information may delay or prevent the receipt of payments through the Automated Clearing House Payment System.

AGENCY INFORMATION

FEDERAL PROGRAM AGENCY

AGENCY IDENTIFIER:

AGENCY LOCATION CODE (ALC):

ACH FORMAT:

CCD+

CTX

ADDRESS:

CONTACT PERSON NAME:

ADDITIONAL INFORMATION:

TELEPHONE NUMBER:

()

PAYEE/COMPANY INFORMATION

NAME

ADDRESS

CONTACT PERSON NAME:

SSN NO. OR TAXPAYER ID NO.

TELEPHONE NUMBER:

()

FINANCIAL INSTITUTION INFORMATION

NAME:

ADDRESS:

ACH COORDINATOR NAME:

TELEPHONE NUMBER:

 

 

 

 

 

 

 

(

)

NINE-DIGIT ROUTING TRANSIT NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEPOSITOR ACCOUNT TITLE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEPOSITOR ACCOUNT NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOCKBOX NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE OF ACCOUNT:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHECKING

 

SAVINGS

 

 

 

 

LOCKBOX

 

 

SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TELEPHONE NUMBER:

(Could be the same as ACH Coordinator)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

AUTHORIZED FOR LOCAL REPRODUCTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SF 3881 (Rev. 2/2003 )

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prescribed by Department of Treasury

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

31 U S C 3322; 31 CFR 210

Instructions for Completing SF 3881 Form

Make three copies of form after completing. Copy 1 is the Agency Copy; copy 2 is the Payee/Company Copy; and copy 3 is the Financial Institution Copy.

1.Agency Information Section - Federal agency prints or types the name and address of the Federal program agency originating the vendor/miscellaneous payment, agency identifier, agency location code, contact person name and telephone number of the agency. Also, the appropriate box for ACH format is checked.

2.Payee/Company Information Section - Payee prints or types the name of the payee/company and address that will receive ACH vendor/miscellaneous payments, social security or taxpayer ID number, and contact person name and telephone number of the payee/company. Payee also verifies depositor account number, account title, and type of account entered by your financial institution in the Financial Institution Information Section.

3.Financial Institution Information Section - Financial institution prints or types the name and address of the payee/company's financial institution who will receive the ACH payment, ACH coordinator name and telephone number, nine-digit routing transit number, depositor (payee/company) account title and account number. Also, the box for type of account is checked, and the signature, title, and telephone number of the appropriate financial institution official are included.

Burden Estimate Statement

The estimated average burden associated with this collection of information is 15 minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to the Financial Management Service, Facilities Management Division, Property and Supply Branch, Room B-101, 3700 East West Highway, Hyattsville, MD 20782 and the Office of Management and Budget, Paperwork Reduction Project (1510-0056), Washington, DC 20503.

How to Edit Ach Payment Enrollment Form

The PDF editor was built with the aim of making it as effortless and easy-to-use as possible. These particular actions will help make creating the ach form pdf quick and easy.

Step 1: To begin, hit the orange button "Get Form Now".

Step 2: Now you are on the file editing page. You can change and add information to the form, highlight specified content, cross or check specific words, add images, put a signature on it, get rid of unrequired fields, or eliminate them altogether.

Prepare the next sections to complete the template:

example of empty fields in blank ach form

Write the required information in the NAME:, ADDRESS:, ACH COORDINATOR NAME:, NINE-DIGIT ROUTING TRANSIT NUMBER:, DEPOSITOR ACCOUNT TITLE:, DEPOSITOR ACCOUNT NUMBER:, TYPE OF ACCOUNT:, TELEPHONE NUMBER: (, LOCKBOX NUMBER:, SIGNATURE AND TITLE OF AUTHORIZED, CHECKING, SAVINGS, LOCKBOX, AUTHORIZED FOR LOCAL REPRODUCTION, and TELEPHONE NUMBER: part.

Filling out blank ach form step 2

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