ACH Direct Deposit Form

ACH Direct Deposit Form
Beginning April 2022, Humanities Kansas scholars, discussion leaders, and consultants will receive payment electronically directly from Humanities Kansas.
- Payment will be deposited directly into the checking account of your choice.
- Payment will be made at the completion of the presentation, discussion, or event and is dependent upon HK receiving requested paperwork.
- An email alert will be sent after each deposit is made and will include the event number and date.
To receive payments electronically, please complete one of the following options:
1. Call Abigail Kaup or Leslie Daugharthy at Humanities Kansas at 785-357-0359 to provide this information over the phone. Information will be kept safe and secure at all times.
2. Complete this form, upload a voided check or bank account certification letter from your financial institution, upload a completed W9, and click submit. Information will be kept safe and secure at all times.
Please do not send bank account information through email.
Payee Information
Name

First NameLast Name
Email address for payment notification
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SSN #
Bank Information
Bank Name
Name on Account
Account Number: 7-12 digits
Routing Number: 9 digits
Upload Voided Check

Do not email voided check.
Cancelof
Upload W-9 Form

Do not email W-9 form.
Cancelof
I hereby authorize Humanities Kansas (HK) to electronically credit the account submitted for payment for services completed. This agreement will be effective until Humanities Kansas is notified by me of a change or a request for cancellation.
Signature

Clear
Print Name
Date

MonthDayYear
Date
Should be Empty:

ACH Direct Deposit Form

Payee Information

Bank Information