iPlanGroup - Expense Payment Authorization Form

Expense Payment Authorization Form

Use this form to pay for an expense related to an asset held in your account.
Account Owner Information
iPlanGroup Account Number*
Account Owner Name*

First NameLast Name
Please verify the last 4 of your SSN*

Asset and Expense Information

Please describe the asset that you are looking to make a payment for.
Asset / Investment Description*
(Brief with No Special Characters $@!^*%)
Description of Expense Payment Category*
Information to be Referenced on Payment (Account Number, Parcel Number, etc.)

(Brief with No Special Characters $@!^*%)0/50
Please provide a copy of the invoice or third-party payment receipt corresponding to this expense request.

(Brief file names with No Special Characters $#@!^*%)
Cancelof
FREQUENCY OF PAYMENT

Tell us how often to process this expense.
One Time PaymentRecurring Payment
MonthlyQuarterlyYearly
When would you like us to submit this payment? *

MonthDayYear
Date

Expense Payment Instructions

Please tell us how you would like us to send the funds.
CheckWire (fees apply)ACH (fees apply)
Regular CheckCashier's Check (fees apply)
Regular MailOvernight Mail (fees apply)Pickup at iPlanGroup Location
Who should we make the check payable to? *
Total Payment Amount for Expense*
Please tell us how much the Expense is.
Check Delivery Instructions*

Company/Person

Address

CityState

Zip Code
Bank Account Type*
Total Payment Amount to be Sent*
Wire/ACH Instructions*

Bank Name

Bank Account Name

ABA Routing NumberState / Province

Bank Account Number
Bank Address

Street Address

Street Address Line 2

CityState

Zip Code

Processing of Fees For Expense Payment
Debit Fees From My AccountMail a CheckPay with Debit/Credit Card
Note : After form submission, you will receive an online payment link via the E-mail address that we have on file for your account.
Account Owner Authorization and Signature

Please read the following, then sign and date.
Calculated Amount of Expense
If this amount is NOT the expected amount, this means that there is still a value entered in the amount field of a previously selected fund delivery method on the last page. Please change the fund delivery method selected above and remove the previously entered dollar value. This field is titled "How would you like us to send the funds?"
Account Owner Signature*

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💡 Time Saving Tip: Use iPlanGroup's new "Save as Template" feature below to quickly create a reusable version of this form. This allows you to pre-fill future submissions with your current information, saving you time on repetitive form entries. A generated hyperlink will reflect the information that you currently have entered into this form. For more information on this feature and or step-by-step instructions on how to use it, click here.
YesNo
Date*

MonthDayYear
Date
Should be Empty:

Expense Payment Authorization Form