ACH ENROLLMENT
AUTHORIZATION FORM
Please enroll me in ACH payments. I authorize Edward Waters College to make refund payments and/or deposits through ACH in the amounts stated by initiating credit entries or correcting entries to the bank accounts (Checking and/or Savings) I have listed below. I understand my deposit will begin after the pre-note process is completed which may take approximately l0 to 15 banking days.
FOR ACTION: Attach a voided check (not a deposit slip) with this request to ensure accurate of your account number.
∘Checking Account #1
Full Net
Dollar Amount
Bank Routing Number (ABA) (Must be nine (9) digits)
Routing Number
Account Number
Account Number
∘Savings Account #1
Full Net
Dollar Amount
Bank Routing Number (ABA) (Must be nine (9) digits)
Account Number
Account Number
By signing below, I acknowledge the information provided to be true and accurate. I also understand that this authority is to remain in full effect until Edward Waters College has received written notification from me to close or change the account and/or dollar amounts.
Student Signature:
Student first & Last Name:
First Name
Last Name
Email
example@example.com
Social Security Number:
Please enter a valid phone number.
Student EWC ID:
must be 9 digits
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date
-
Month
-
Day
Year
Date
For Dept. of Business & Finance Use Only
There is no fee for this benefit. The refund payment owed may be deposited to ONE, TWO or THREE bank accounts (Checking and/or Savings). Please complete and deliver this form to Accounts Payable by email at accountspayable@ewc.edu or by fax at (904) 470- 8044
Date Received by Accounts Payable
-
Month
-
Day
Year
Date
Received by:
Student/Vendor ID Number:Type a question
Submit
Should be Empty: