Corporate Authorization for Direct Payment via ACH
Direct Payment via ACH is the transfer of funds from a non-consumer (corporate) account for the purpose of making a payment.
Check One:
Begin Payment
Change Information
I (we) authorize Tax Consultants, Inc., to electronically debit my (our) account and, if necessary, to electronically credit my (our) account to correct erroneous debits as follows at the depository Financial Institution named below (“DEPOSITORY”). I (we) agree that ACH transactions I (we) authorize comply with all applicable laws (select one):
Checking Account
Savings Account
Bank Name
Routing Number
Account Number
Name(s) on the account
Start Date
Debit Transaction Frequency
Single Entry (one-time payment)
Recurring Entries (see below)
Recurring Entries (entries that recur at substantially regular intervals, without further affirmative action by the Receiver)
Daily
Weekly
Bi-weekly
Monthly
Other (specify below)
Add "other" from above (if checked)
Authorized debit amount (or method for determining amount):
I (we) understand that this authorization will remain in full force and effect until I (we) notify Tax Consultants, Inc., in writing that I (we) wish to revoke this authorization. I (we) understand that Tax Consultants, Inc., requires at least 7 days prior notice in order to cancel this authorization. Both parties subject to this authorization agree to be bound by the Nacha Operating Rules & Guidelines and United States Law.
By typing your name below, you agree this constitutes your electronic signature and carries the same legal effect as a handwritten signature.
Name of Company
Authorized Representative(s):
Printed Name
First Name
Last Name
Title
Date
-
Month
-
Day
Year
Date
Please attach a voided check
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