How to fill out ACH authorization forms Business or customer name. Email address for online payments. The name of the bank. Amount. The type of account. Account number. Type of transaction. Statement for permitting future debits with a disclaimer that the transaction is revocable. You can find various templates online.
Begin by specifying your name, the entity authorized to disclose information, and the individuals or entities you authorize to receive it. Indicate the specific information and purpose for which it will be disclosed, add an expiration date or event, and sign and date the form to confirm your consent.
To make a transfer, you'll need to provide your name, routing/ABA number, account number, account type, and transaction amount.
I (we) agree that ACH transactions I (we) authorize comply with all applicable law. Amount of debit(s) or method of determining amount of debit(s) or specify range of acceptable dollar amounts authorized: ______________________________________________.