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ApplyMerchant/Payee Name: [Business Name]
[Address]
[Phone] | [Email]
[Website (Optional)]
Payer Name: [Full Name/Business]
Account/Customer ID (Optional): [__]
Date: [Date]
1.1 Debit Type (Select One):
☐ Fixed recurring amount
☐ Variable recurring amount (amount may change)
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): [____]
3.1 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.].
4.1 If the amount changes, Merchant will provide notice: ☐ [__] days before debit ☐ via email ☐ via invoice ☐ other: [Method].
5.1 If a debit is returned, Merchant may retry [**] times.
5.2 Returned payment/NSF fee: $[**] (if permitted).
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.
7.1 Bank information will be used only for processing payments and stored securely with limited access.
Payer / Authorized Representative: [Full Name]
Date: [Date]
Signature: ___________________________
Merchant Representative (Optional): [Name]
Date: [Date]
Signature: ___________________________
Each template already follows legal structure and best practices.
The agreement is automatically filled and adapted to your inputs.
Check the generated document, make edits if needed, and download a ready-to-use agreement.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
Frequently asked
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.
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).
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.
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.
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.
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