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Department Use Only Location Registration Date ELECTRONIC FUNDS TRANSFER AUTHORIZATION AGREEMENT See reverse for instruction SECTION I A. Business Name B. Employer Account Number C. Business address.

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How to fill out the See Reverse For Instructions online

Completing the See Reverse For Instructions form online can streamline your electronic funds transfer enrollment process. This guide will walk you through each section of the form, ensuring you complete it accurately and efficiently.

Follow the steps to complete your form online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. In Section I, fill in your business name, employer account number, business address including street number, city, state, and zip code, and business phone number. Ensure all information is accurate to avoid delays.
  3. In Section II, for ACH Debit, indicate your bank name, account number, and routing transit number. Choose whether the account is checking or savings. Remember to attach a voided check or bank specification sheet as required.
  4. Section III covers ACH Credit, where you authorize the transfer of funds. Ensure you understand the implications of this authorization.
  5. Once all sections are filled out accurately, you can save your changes, download, print, or share the completed form as needed. Follow any additional directions provided for submission.

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