CFA Fiscal Sponsorship ACH Deposit Authorization Form

To receive your disbursement via ACH direct deposit, you will need to designate a bank account to receive funds. To do this, please fill out the ACH AUTHORIZATION FORM below.

New projects and projects that have not yet received funds via ACH need to submit this form as soon as possible.

Please note, there is a 7 business day clearance to set up your ACH account before a disbursement can be made.

IMPORTANT: The beneficiary name and address on this form MUST match the beneficiary name and address on your W9. If your account belongs to an LLC, the beneficiary name must be the LLC name, not name of the project representative.

If you have already received disbursements via ACH and we have your banking information on file, you do NOT need to fill out this form unless you are changing your account information.

Project Name*

Project Number*

Enter as 4010-05-***. If you do not yet have a project number, please enter N/A

Beneficiary Name on Account*

Bank Name*

ACH Routing Number*

Bank Account Number*

CheckingSavings

AUTHORIZATION:

I hereby authorize Cinematography for Actors Institute Inc. to initiate credit entries for Fiscal Sponsorship Disbursement Requests to my account with the financial institute I have listed above. I understand that ACH credit deposits will only occur once a Disbursement Request Form is submitted through the Fiscal Sponsorship Project Management Page.

I understand that this account will remain on file until my contract ends or I submit written notice of an account change.

NOTE: All funds must be disbursed into a production or designated individual bank account directly affiliated with the project. You cannot, under any circumstances, pay a vendor or debtor directly from your fiscal sponsorship.

Signature of Project Representative (as per fiscal sponsorship agreement)*

Name of Project Representative*

First NameLast Name

Phone Number of Project Representative*

Email of Project Representative*