Unlock hundreds more features
Save your Form to the Dashboard
View and Export Results
Use AI to Create Forms and Analyse Results

Forgot Password?
Get Started
OR
Sign UpLogin With Facebook
Sign UpLogin With Google

ACH Authorization Form Template

Streamline Electronic Payments with Ease

If managing electronic payments feels overwhelming, you're not alone. This ACH Authorization Form template is designed for businesses and organizations that need to facilitate seamless payment authorizations for their customers or vendors. With this template, you can enhance transaction security, speed up payment processing, and ensure compliance with banking regulations, all while reducing errors and gathering necessary information. Plus, our ACH Authorization Form is user-friendly and WCAG-aligned, making it accessible for everyone. Try out the live template and simplify your payment authorizations.

Use this Template (FREE) Live Preview
Full name
Company or organization (if applicable)
Email address
Phone number
Street address
City
State/Province
Postal/ZIP code
Country
Business name authorized to debit (Originator)
Authorization type
One-time debit
Recurring debits
Authorized debit amount (enter fixed amount or maximum if variable)
Start date
End date (if applicable)
Payment description or purpose
Invoice or reference ID (optional)
Debit frequency
One-time
Weekly
Every 2 weeks
Monthly
Quarterly
Annually
Name on bank account
Bank name
Routing number (9 digits)
Account number
Confirm account number
Account type
Checking
Savings
Business checking
Business savings
I am an authorized signer on this bank account
Yes
No
I authorize the business named above to electronically debit my account for the amount(s) and schedule specified and to credit entries for error corrections if necessary
Yes
No
I understand this authorization will remain in effect until I notify the business in time to act, and I may revoke authorization by contacting the business
Yes
No
Signature
Date of signature
{"name":"Full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Full name, Company or organization (if applicable), Email address","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration representing ACH authorization form template for FormCreatorAI article

When to use this form

Use this form when you need permission to pull funds from a customer's bank account. It suits recurring invoices, memberships, rent, tuition, donations, or installment plans. Vendors and contractors can also use it to receive direct deposit for payouts. You get predictable cash flow, lower card fees, and fewer missed payments. For clients who prefer banking details on file, pair it with the ACH Client authorization form. If you issue confirmations after each debit, send a Payment receipt form for a clear record. For one-off invoices or deposits, you can first send a Payment request form, then capture bank consent here. Finance, billing, and operations teams all benefit from a clear audit trail and fewer back-and-forths.

Must Ask ACH Authorization Questions

  1. Who is the account holder (legal name and business name, if applicable)?

    The name must match bank records to prevent returns and fraud flags. It also tells you whether to store the record under a person or company.

  2. What is the bank routing number and account number?

    These numbers drive the transfer; asking for them together reduces typos. Prompt the payer to confirm the 9-digit routing number and full account number.

  3. Is this a checking or savings account?

    Account type affects processing and compliance settings. Capturing it up front avoids delays if the bank blocks an unsupported type.

  4. Is the payment one-time or recurring, and what amount, frequency, and start date do you authorize?

    Clarity on timing and amount is key to consent and dispute defense. For ad hoc invoices, you can pair this with a Payment request form to collect the exact amount before authorization.

  5. Do you agree to the authorization terms and provide your signature and date?

    A signed yes, with date, proves informed consent and protects you in a review. Mirror the language in your Payment authorization form so records stay consistent.

More Forms

Copy/Edit Form Send to Recipients Make a Form w/AI Form Builder Must Ask Questions
  • 100% Free - No Catches
  • Collect Responses Today
  • Tailor to your Look & Feel