ACH Revocation Letter / Stop ACH Authorization Letter Template

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Date: [Date]

Sent Via: ☐ Email ☐ Certified mail ☐ Fax ☐ Other: [Method]

To (Merchant/Payee): [Merchant Name]

Attn: Billing/Payments Department

[Address]

[Email/Fax]

From (Payer): [Your Full Name]

[Your Address]

[Phone] | [Email]

Re: Revocation of ACH Authorization — Stop ACH Debits

Dear Billing/Payments Department,

1. Revocation Notice

1.1 I am writing to revoke and cancel any and all authorization previously given to [Merchant Name] to initiate ACH debits (electronic withdrawals) from my bank account.

1.2 This revocation is effective immediately (or effective on): [Effective Date].

2. Account Information (Limited)

2.1 Customer/Account ID (If Any): [__]

2.2 Bank Name (Optional): [Bank]

2.3 Account (Last 4 Digits Only): [____]

2.4 Authorization Reference (If Any): [Date signed / reference #]

3. Stop Payment Request

3.1 Please stop initiating any ACH debits to my account immediately (or as of the Effective Date).

3.2 If any debit is scheduled after the Effective Date, it is not authorized.

4. Written Confirmation Requested

4.1 Please confirm in writing that you have processed this revocation and that no further ACH debits will be initiated.

4.2 Confirmation may be sent to: [Email] and/or [Mailing address].

5. Contact

5.1 If you need to confirm details, contact me at [Phone/Email].

5.2 Please do not request sensitive bank information by email.

Sincerely,

[Your Full Name]

Signatures

Signature: ___________________________

Printed Name: [Your Full Name]

Date: [Date]

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ACH Revocation Letter / Stop ACH Authorization Letter Template

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ACH Revocation Letter / Stop ACH Authorization Letter Template — quick answers

Reviewed July 2026 Free download, PDF & DOCX

What is an ACH revocation letter?

An ACH Revocation Letter is a written notice to a merchant or payee that you are revoking authorization for them to debit your bank account via ACH. It’s commonly used to stop recurring debits for subscriptions, memberships, or services.

Should you notify your bank too?

Often yes. In many cases, you should send the revocation to the merchant and also contact your bank to place a stop payment order if needed. This template focuses on the notice to the merchant/payee, not the bank process.

What information should be included?

Include: your name, account or customer ID, the bank account (use last 4 digits only), the authorization you are revoking, and the effective date. This template also includes a request for written confirmation.

How should you send it?

Use a method that creates a record — email plus certified mail is common. This template includes a delivery method line and a request for confirmation.

What if they keep debiting your account?

If debits continue after revocation, contact your bank promptly and dispute unauthorized transfers according to your bank’s procedures. Keep proof of your revocation letter and delivery.

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