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ACH Payment Setup Form
If your bank account information changes at any time, you are required to notify HGreg Accounts Payable immediately at payables@hgreg.com and resubmit this form. Failure to notify us of changes may result in misdirected or failed payments.
Company Name
*
Contact Name
First Name
Last Name
Email
example@example.com
Bank Name
*
Account Holder Name (as it appears on the bank account)
*
Account Type
*
Checking
Savings
Other
Routing Number (9 digits)
*
Account Number
*
Date
*
-
Month
-
Day
Year
Date
Upload a voided check and payment instructions on a company letterhead
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Signature
*
By signing this form I confirm that the banking information provided is accurate and I authorize HGreg to initiate ACH transactions to the account listed above
Submit
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