Get Payment Authorization Form

Completing the Payment Authorization Form online is essential for securely authorizing debits from your account. This guide will provide you with clear, step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete your Payment Authorization Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the authorization date next to 'Written Notification of TEL Transaction.' This date marks when the customer authorized the debit.
3. Insert the customer’s name in the designated area where it states '(customer name).' Make sure to enter the full legal name for proper identification.
4. Fill in the date of the incoming phone call where the authorization was granted on the line provided.
5. Enter the customer's routing number in the corresponding section. Ensure that the formatting is correct with nine digits total.
6. Provide the customer's account number in the specified area. Double-check that this number is accurate to avoid processing issues.
7. Indicate the check number, if applicable, reminding customers to VOID that check and deduct the amount from their balance.
8. Specify the date when the electronic debit will take place. This should be on or after the date indicated earlier.
9. Provide contact information for your business should the customer have any questions regarding this transaction.
10. If applicable, note the fee that will be charged if the telephone-initiated debit is returned. Ensure the fee complies with the customer's state's laws.
11. Fill in the email and fax information for sending this notice to the customer. This includes fields for the customer’s name, email address, and fax number.
12. After completing all required fields, save your changes, download a copy, print it as needed, or share the form electronically.

Complete your Payment Authorization Form online today for efficient processing!