Direct Deposit Authorization Form (ACH)

Direct Deposit Authorization Form (ACH)

Community Foundation of Acadiana
Community Foundation of Acadiana is committed to improving the efficiency of our payment process and excited to announce that we are launching ACH Direct Deposit for grantee and vendor payments.

ACH Direct Deposits are a more direct way for nonprofits to receive funds. In order to begin receiving grant distributions via ACH, please take a moment to complete the form below. The information on the form is required to ensure accurate processing of all ACH deposits and will be kept confidential and secure. We will send an email to the primary contact specified on the form when an ACH Direct Deposit is made to your organization's account and a follow-up email with details about the contribution. If you have any questions, please contact finance@cfacadiana.org.

*THIS FORM REQUIRES A VOIDED CHECK*
Bank/Financial Institution Name*
Bank/Financial Institution Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Routing Number*
must be 9 numbers
Account Number*
Organization's Name on Account*
Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank Account Type*
Please upload a voided check.*

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VOIDED CHECK Cancelof
Organization Tax EIN#*
00-0000000
Primary Contact Name*
Primary Contact Email*
example@example.com
Primary Contact Phone*
I hereby authorize Community Foundation of Acadiana to make an ACH deposit directly into the above specified account. This authorization will remain in effect until l have given written notice that I am terminating this contract, or until Community Foundation of Acadiana has notified me that this deposit service has been discontinued. I understand that I must give advance notice to allow reasonable time for my instruction to be executed. If an incorrect deposit should be made into my bank account, I authorize Community Foundation of Acadiana to make the appropriate adjustment(s). I acknowledge that the origination of ACH transactions to my account must comply with the provision of U.S. law. If any information on this form changes, I will submit a new Authorization Agreement.
Signature*
Date*

MonthDayYear
Date
Should be Empty: