ACH Authorization Form for Compass Dealer Services LLC

ACH Authorization Form for Compass Dealer Services LLC

Complete the form to authorize ACH deposits and ensure accurate routing and account information.
The signer is authorized and does authorize Compass Dealer Services LLC to initiate electronic ACH deposits for commission payments and other amounts due under the Affiliate Agreement, and authorizes correction of erroneous deposits by debit entries limited to the amount of the error. This authorization remains in effect until written termination notice is received by Compass Dealer Services LLC with reasonable opportunity to act. The signer certifies they are an authorized representative of the agent and that the information provided is accurate.
Business/Legal Name of Affilate*
DBA (if applicable)
Affiliate Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Primary Contact Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Bank Name*
Bank Address or City*
Account Type*

CheckingSavings
Routing Number (9 digits)*
Confirm Routing Number*
Account Number*
Confirm Account Number*
Name on Bank Account*
Authorized Signer Name*

First NameLast Name
Title/Position*
Authorization: By signing below, the affiliate authorizes Compass Dealer Services LLC to initiate electronic ACH deposits for commission payments and other amounts due under the Affiliate Agreement, and authorizes correction of erroneous deposits by debit entries limited to the amount of the error. This authorization remains in effect until written termination notice is received by Compass Dealer Services LLC with reasonable opportunity to act. The signer certifies they are an authorized representative of the agent and that the information provided is accurate.
Signature (draw or type)*
Date*

MonthDayYear
Date
Should be Empty: