ACH Authorization Form

QUICK LOOK — The ACH Authorization Form is a single signed sheet a business uses to set up recurring bank payments, capturing the account holder, bank details, amount and frequency, and the standard cancel-in-writing clause.

What's inside

• Account holder block for name, address, phone, and email
• Bank information: bank name, routing number, and account number
• Account type and payment frequency as tick boxes
• Authorization statement with signature, printed name, and date, including the standard cancel-in-writing clause
• Both a full-color layout and a black-and-white ink-saver version

What you get

• Two print sizes: US Letter and A4
• An editable Word (.docx) version you can type into, plus a clean print-ready layout
• Instant download — the files are yours the moment you check out

Who it's for

• Businesses and service providers setting customers up on automatic recurring billing
• Landlords or property managers collecting rent by bank draft
• Anyone who needs a signed record authorizing debits from a checking or savings account

How to use it

1. Download and open the editable Word file, or use the ready-made print layout.
2. Prefill your company name once, then rename or add any fields you need.
3. Print a copy and have the account holder fill in their bank details, tick their account type and frequency, then sign and date.
4. Keep the signed form on file and reuse it for every new customer.