ACH Authorization

Direct Deposit Authorization (EFT)

(EFT = Electronic Funds Transfer)
Name*

First NameMiddle InitialLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Today's Date*

MonthDayYear
Date
Type of Bank Account*

CheckingSavingsOther
Financial Institution*
Financial Institution Address*
Street address, City, State, Zip Code
Name(s) on Bank Account (business/trust name if used)*
Routing Number*
must be 9 numbers - no spaces
Account Number*
cannot exceed 17 digits
Financial Institution Phone Number

Area CodePhone Number
For Direct Deposit using a Checking Account: An image of a VOIDED check is required to complete your direct deposit request. If you do not have a check, please attach a letter from your financial institution on their buisness letterhead that includes their routing number, your account number and an authorized signature.

For Direct Deposit using a Savings Account: A letter from your financial institution is required. Letter must be on their business letterhead and include their routing number, your account number and authorized signature.
Take a photo of a VOIDED check or bank letter here.
Upload a file (if needed) here.

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Direct Deposit Authorization (EFT)