Authorization Agreement Direct Payments (Ach Debits) Form 2015
Download a blank fillable Authorization Agreement Direct Payments (Ach Debits) Form 2015 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Authorization Agreement Direct Payments (Ach Debits) Form 2015 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1AUTHORIZATION AGREEMENT
DIRECT PAYMENTS (ACH DEBITS)
I (we) hereby authorize GECU, hereinafter called COMPANY, to debit entries to my (our) account indicated below and the
Financial Institution named below, hereinafter called FINANCIAL INSTITUTION, to debit same to such account. I (we)
acknowledge the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.
FINANCIAL INSTITUTION
(Financial Institution Name)
(Address)
(City-State)
(Zip)
DONOR ACCOUNT
Checking
Savings
__________________________
__________________________
(Account Type)
(Routing/Transit Number)
(Account Number)
Recurring Amount: $ _______________________
Final Amount: $ _______________________
RECIPIENT ACCOUNT
Checking
Savings
Consumer Loan
GECU Credit Card
_______________________
(Account Type)
(Account Number)
SELECT A SCHEDULE
Recur Every: _______ days
Daily:
(1-31)
Recur Every: _______ weeks on ____________________
Weekly:
(1-5)
(Monday, Tuesday, etc)
_______ day and _______ day of every month.
Semi-Monthly:
(1-15)
(16-31)
_______
_________________ of every
_________ month(s).
Monthly:
( “Day” or “Monday”)
(1-31)
(1-12)
_______
_________________ of
______________________
Yearly:
(“Day” or “Monday”)
(1-31)
(January, February, etc)
Range +/-
Days
* I (we) wish to have recurring transactions that fall on non-banking days to be processed on the
closest banking day BEFORE the scheduled date.
DURATION
Starting:
Date: _________________
Ending:
Date: _________________
or
After _________ Occurrences
This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of
its termination in such time and manner as to afford COMPANY and FINANCIAL INSTITUTION a reasonable opportunity to
act on it. This Agreement shall be governed by the laws of the State of Texas and the rules of the National Automated
Clearing House Association.
For Office Use Only
(Print Individual Name)
Issued Tracking Number:
______________________________
(Signature
(Date)
Please fax this form to (915) 538-2975 or email to:
Rev.5/4/15
1
ADVERTISEMENT
0 votes
Related Articles
Related forms
Authority To Make Direct Payments (ach Debits) - Liquor Division - State Of Wyoming - Department Of Revenue Form
Financial
Authorization Agreement For Preauthorized Payments (ach Debits) - New Hampshire Insurance Department
Legal
Form Dr 5778 - Eft Authorization Corporate Estimated Income Tax Ach Debit/form 112ep - Corporate Estimated Tax Payment Vouchers - 2009
Financial
Related Categories
Parent category: Legal