Authorizes a company to initiate ACH debit entries from an account holder's bank account for recurring or one-time payments. Complies with NACHA Operating Rules requirements for written authorization.
The ACH Debit Authorization is a ready-to-use records & authorization template you can send for signature in minutes. It is written for 1 signer (account holder) and, by default, expires 30 days after it is sent if left unsigned. It covers ach, debit authorization, nacha, automated clearing house, bank debit, recurring payment. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# ACH Debit Authorization This ACH Debit Authorization Form is executed as of ___________ by the Account Holder identified below. This authorization is required by the National Automated Clearing House Association (NACHA) Operating Rules and Regulation E (12 C.F.R. Part 1005) to permit the initiation of electronic debit entries to the Account Holder's designated bank account. --- ## 1. Company Initiating Debits **Company Name:** ___________ **Company Description / Purpose:** ___________ **Company ID (NACHA):** ___________ **Company Contact / Customer Service:** ___________ **Company Phone:** ___________ **Company Email:** ___________ --- ## 2. Account Holder Information **Account Holder Full Legal Name:** ___________ **Account Holder Street Address:** ___________ **City, State, ZIP:** ___________ **Account Holder Email:** ___________ **Account Holder Phone:** ___________ --- ## 3. Bank Account Information **Bank Name:** ___________