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ACH Client Authorization Form Template

Streamline Your ACH Payments with Our Easy Template

Are you struggling to manage automatic ACH payments from your clients? This ACH Client Authorization Form Template is designed for businesses like yours to simplify payment authorizations. With our easy-to-use template, you can quickly gather necessary bank details, obtain client consent, and ensure secure transactions, reducing administrative headaches, speeding up processing times, and enhancing customer satisfaction. Experience a boost in efficiency with our compliant and customer-friendly form, ready for your use.

Use this Template (FREE) Live Preview
Full legal name
Company or organization (if applicable)
Email
Phone
Billing address
Payee or business name
Customer or account ID with payee (if applicable)
Invoice or reference (if applicable)
Bank name
Routing number
Account number
Account type
Checking
Savings
Business checking
Other
Please Specify:
Transaction type
Debit (pull funds from my account)
Credit (deposit funds to my account)
Both debit and credit
Payment frequency
One-time
Weekly
Every two weeks
Twice per month
Monthly
Quarterly
Annually
As invoiced
Payment date (for one-time payments)
Start date (for recurring payments)
End date (if applicable)
Amount authorized per transaction (specify currency if not USD)
Maximum total amount authorized (optional)
Description or purpose of payment
Duration
Until canceled by me
End on the date below
I understand I may revoke this authorization by contacting the payee with reasonable notice.
Yes
No
I acknowledge that returned or rejected entries may result in applicable fees.
Yes
No
I agree to sign and receive this authorization electronically.
Yes
No
Typed signature (enter your full name)
Signature date
Title or role (if signing on behalf of a business)
I authorize the payee named above to initiate ACH entries to the bank account indicated and, if necessary, to correct entries in case of error, in accordance with applicable rules and law.
Yes
No
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Paper art illustration showcasing ACH Client Authorization Form Template with design elements related to finance and forms

When to use this form

Use this template when you need written permission to debit a client's bank account. It fits recurring retainers, memberships, tuition, rent, and scheduled invoice payments. It also works for one-time ACH pulls for projects or deposits. You will collect account holder details, routing and account numbers, debit limits, and timing so you can process payments on time and reduce returns. Pair it with an Invoice request form to capture billing references, and record deposits with the Daily remittance entry form for quick reconciliation. If a customer prefers another method for a single payment, offer the Paypal payment form instead. Clear authorization shortens your A/R cycle, cuts manual follow-up, and gives both sides a record to reference.

Must Ask ACH Client Authorization Questions

  1. What is the account holder's legal name and business entity (if applicable)?

    Exact legal names must match bank records to prevent rejects and reduce compliance issues. This also confirms who is granting permission, which protects you and your client.

  2. Which bank account will be debited (routing number, account number, and account type)?

    These fields let your processor initiate the ACH correctly and verify account format. Capturing account type helps you apply the right rules for consumer versus business debits.

  3. Do you authorize a single debit or recurring debits, and what amount, frequency, and start/end dates apply?

    Scope and schedule define what you are allowed to pull, which reduces disputes and chargebacks. It also lets you automate billing and send required notices before each draw.

  4. What billing reference should we include on each debit (invoice number, customer ID, or memo)?

    References connect each payment to the correct work order or invoice so your team can reconcile fast. This is especially helpful when you post daily deposits or reconcile batches.

  5. How can you revoke authorization, and who should we contact for disputes or changes?

    Clear revocation steps and contact info let clients stop debits without friction and help you resolve issues quickly. For refunds or payouts you approve, direct them to the Payment withdrawal form.

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