ACH Authorization Form

ACH Authorization Form - CCEA

If you have already received a disbursement from CCEA via ACH, and we have your banking information on file, 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*

CheckingSavings
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 *
First and Last Name
Phone Number of Project Representative *
Email of Project Representative *
Signature of Project Representative (as specified in fiscal sponsorship application)*

Clear
Should be Empty:

ACH Authorization Form - CCEA