ACH Authorization

Credit/Debit ACH Authorization Form
Name*

First NameLast Name
Email*
example@example.com
Name(s) on Bank Account (business name if used)*
Bank Name*
Bank Branch*
City, State
Bank Phone Number
Type of Bank Account*

Business CheckingBusiness SavingsPersonal CheckingPersonal Savings
Date*

MonthDayYear
Date
Routing Number*
must be 9 numbers - no spaces
Confirm Routing Number*
must be 9 numbers - no spaces
Routing Numbers do not match
Account Number*
must be 9-12 numbers - no spaces
Confirm Account Number*
must be 9-12 numbers - no spaces
Account Numbers do not match
** IMPORTANT INFORMATION **

Please confirm that your Routing Number and Account Number are correct. Camera Crews, Inc. is not responsible for any errors in the numbers provided. Incorrect numbers could result in payment delay or payment to an account that is not yours. Once payment is sent to the routing and account numbers you provided, Camera Crews, Inc. has no way to retrieve said payment and you will be considered to have been paid in full. Please notify us immediately regarding any change occurring at the financial institution that may delay or prevent the receipt of payments.
Signature*

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Credit/Debit ACH Authorization Form