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What is an ACH Authorization Form?

Businesses must be granted permission to charge or refund a bank account for a customer or a business. An ACH Authorization Form allows you to obtain such permission.

Sample ACH Authorization Form

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I, , authorize to charge my bank account below for on . of week.


This payment is for .


Billing Information


Billing address: , ,

Phone number:



Bank (ACH) Information


Type of account:

Name on account:

Bank name:

Bank city/state:

Account number:

Routing number:


For ACH debits to my account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted transaction date. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this bank account and will not dispute billing my bank account so long as the transaction corresponds to the terms indicated in this authorization form.




___________________________________ Date:


ACH Authorization Form FAQs

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  • What is an ACH transfer?

    An ACH transfer is a method of transferring money electronically between different banks. It is typically used as a replacement for writing checks or paying with a credit or debit card, which can be considered simpler and cost-efficient.

  • What information do I need to provide for an ACH transaction?

    Information that is typically needed for an ACH transaction:

    • Customer or business name
    • Routing number
    • Account number
    • Transaction amount and type (e.g. one-time, recurring, etc.)
  • How do I get an ACH Authorization Form?

    An ACH Authorization Form is easy to make online. our document builder will create a customized document for you after you've answered a few short questions. Consider the following details before starting your ACH Authorization Form to make the process faster:

    • What type of payment will you be authorizing (one-time or recurring)?
    • Why is payment being made?
    • Will a fee be charged for Non-Sufficient Funds (NSF)?
    • Will funds be withdrawn from a savings or checking account?

ACH Authorization Form document preview

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