Electronic Funds Transfer Authorization
ACH = Automated Clearing House
Your Association Name
*
Your Account Number
Your Full Name
*
First Name
Last Name
Your Email for Confirmation
*
example@example.com
Name(s) on Bank Account (Business Name if Used)
*
Your Bank Name
*
Attach a Voided Check Here
*
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Routing Number
*
Must be 9 Numbers - No Spaces
Account Number
*
9 - 12 Numbers - No Spaces
Type of Bank Account
Personal Checking
Personal Savings
Business Checking
Business Savings
Today's Date
*
-
Month
-
Day
Year
Date
Signature
*
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Should be Empty: