ACH Authorization

ACH Authorization
If this project has already received an ACH disbursement from CCEA, and your banking information hasn't changed, you do not need to fill out this form.
Project Name
Beneficiary Name on Account
Bank Name
ACH Routing Number
Bank Account Number
Account Type
Account Type
AUTHORIZATION:

I hereby authorize Center for Cinematic and Experimental Arts 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.

I understand that this account will remain on file with CCEA until my contract ends or I submit written notice of an account change.
Name of Project Representative (as specified in fiscal sponsorship application)
Phone Number of Project Representative
Email of Project Representative
Is this account enrolled in Zelle for smaller transfers, if needed?
Please provide the email address or phone number associated with the Zelle account.
Signature of Project Representative
Should be Empty: