ACH Direct Deposit Form for Grantees

ACH Direct Deposit Form for Grantees
Humanities Kansas grants are paid electronically directly from Humanities Kansas.
- Payment will be deposited directly into the organization's checking account upon receipt of the signed grant agreement.
- 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 Leslie VonHolten 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 and upload a voided check or bank account certification letter from your financial institution. Information will be kept safe and secure at all times.
Please do not send bank account information through email.
Payee Information
Project Director or Fiscal Officer

First NameLast Name
Organization
HK Grant Number
Email address for payment notification
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
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
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 for Grantees

Payee Information

Bank Information