Free template

Recurring ACH Debit Authorization Template

Draft your custom agreement in seconds with AI Lawyer

Recurring ACH Debit Authorization Template

Download template

Recurring ACH Debit Authorization Template


Merchant/Payee Name: [Business Name]
[Address]
[Phone] | [Email]
[Website (Optional)]

Payer Name: [Full Name/Business]
Account/Customer ID (Optional): [__]
Date: [Date]


1. Authorization Type

1.1 Debit Type (Select One):
☐ Fixed recurring amount
☐ Variable recurring amount (amount may change)


2. Bank Account Information (Handle Securely)

2.1 Account Holder Name: [Name]
2.2 Bank Name: [Bank]
2.3 Account Type: ☐ Checking ☐ Savings
2.4 Routing Number: [Routing]
2.5 Account Number: [Account No.]
2.6 Last 4 digits (for confirmation): [____]


3. Debit Schedule and Amount

3.1 Start Date: [Start Date]
3.2 Frequency: ☐ Weekly ☐ Biweekly ☐ Monthly ☐ Quarterly ☐ Annually ☐ Other: [Frequency]
3.3 Amount (If Fixed): $[Amount] per debit.
3.4 Amount (If Variable): Based on: [Usage/plan], calculated as: [Method].
3.5 Maximum Debit (Optional): $[Max] per billing cycle.
3.6 Payment Description: [Membership, invoice, loan payment, etc.].


4. Notice of Changes (Optional)

4.1 If the amount changes, Merchant will provide notice: ☐ [__] days before debit ☐ via email ☐ via invoice ☐ other: [Method].


5. Returned Payments and Fees (Optional)

5.1 If a debit is returned, Merchant may retry [] times.
5.2 Returned payment/NSF fee: $[
] (if permitted).


6. Cancellation / Revocation

6.1 To cancel, Payer must provide written notice by: ☐ email ☐ phone ☐ online portal ☐ mail to [Contact].
6.2 Notice must be received at least [__] business days before the next scheduled debit to stop that debit.


7. Data Handling (Optional)

7.1 Bank information will be used only for processing payments and stored securely with limited access.


Signatures

Payer / Authorized Representative: [Full Name]
Date: [Date]
Signature: ___________________________

Merchant Representative (Optional): [Name]
Date: [Date]
Signature: ___________________________

Flash deal

Flash deal

Today

Today

No time to fill it up? Generate your custom agreement with AI Lawyer in seconds

What’s Included

Legal Research

Legal Research

Legal Research

Contract Drafting

Contract Drafting

Contract Drafting

Document Review

Document Review

Document Review

Risk Analytics

Risk Analytics

Risk Analytics

Citation Verification

Citation Verification

Citation Verification

Easy-to-understand jargon

Easy-to-understand jargon

Easy-to-understand jargon

Details

Learn more about

Recurring ACH Debit Authorization Template

Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.

Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.

RECURRING ACH DEBIT AUTHORIZATION TEMPLATE FAQ


What is a recurring ACH debit authorization?

A Recurring ACH Debit Authorization is a written permission allowing a business to withdraw funds from a customer’s bank account on a recurring schedule. It’s commonly used for memberships, subscription services, installment plans, loan payments, and ongoing service fees.


Can the amount change over time?

Yes, but variable amounts should be disclosed clearly, including how amounts are determined and what notice will be provided. This template includes both fixed and variable amount options and a maximum debit (optional).


How does cancellation work?

Customers typically can revoke authorization by giving written notice before the next debit, subject to timing requirements. This template includes a notice period field and a cancellation contact method.


What should the authorization include?

Include: account holder details, bank details, debit schedule, start date, amount or calculation method, and signature. This template also includes a “returned payment” section and secure data handling notes.


What is AI Lawyer?

AI Lawyer is an AI-powered assistant that helps you create and customize legal and business document templates online. It guides you through key sections, suggests wording, and explains complex concepts in simple language. AI Lawyer does not replace a licensed attorney or provide legal advice, but helps you prepare better documents faster and more confidently.

Similar templates

Other templates from

Financial Agreements

Money back guarantee

Free trial

Cancel anytime

AI Lawyer protects

your rights and wallet

🌐

Company

Learn

Terms

©2026 AI Lawtech Sp. z O.O. All rights reserved.

Money back guarantee

Free trial

Cancel anytime

AI Lawyer protects

your rights and wallet

🌐

Company

Learn

Terms

©2026 AI Lawtech Sp. z O.O. All rights reserved.

Money back guarantee

Free trial

Cancel anytime

AI Lawyer protects

your rights and wallet

🌐

Company

Learn

Terms

AI Lawtech Sp. z O.O.

©2026

Money back guarantee

Free trial

Cancel anytime

AI Lawyer protects

your rights and wallet

🌐

Company

Learn

Terms

©2026 AI Lawtech Sp. z O.O. All rights reserved.