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Vendor ACH Authorization / Vendor Direct Deposit Form Template

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Vendor ACH Authorization / Vendor Direct Deposit Form Template

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Vendor ACH Authorization / Vendor Direct Deposit Form Template


Paying Company: [Your Company Name]
Accounts Payable Contact: [Name/Email/Phone]
Vendor ID (Optional): [Vendor ID]
Date: [Date]


1. Vendor Information

1.1 Vendor Legal Name: [Vendor Name]
1.2 DBA/Trade Name (If Any): [DBA]
1.3 Tax ID (Last 4 digits only) (Optional): [____]
1.4 Business Address: [Address]
1.5 Primary Contact Name/Title: [Name/Title]
1.6 Email/Phone: [Email] / [Phone]


2. Payment Method Authorization

2.1 Vendor authorizes [Paying Company] to initiate ACH credit entries (direct deposit) to the account listed below for payment of approved invoices.
2.2 Payment Frequency (Optional): ☐ Weekly ☐ Biweekly ☐ Monthly ☐ Per invoice ☐ Other: [].
2.3 Remittance Advice Delivery: ☐ Email ☐ Portal ☐ Mail ☐ Other: [
].


3. Banking Details (Handle Securely)

3.1 Bank Name: [Bank Name]
3.2 Bank Address (Optional): [Address]
3.3 Account Holder Name: [Name as on account]
3.4 Account Type: ☐ Checking ☐ Savings
3.5 Routing Number: [Routing]
3.6 Account Number: [Account No.]
3.7 Account Number (Last 4 digits for confirmation): [____]


4. Verification (Recommended)

4.1 Provide one of the following (recommended):
☐ Voided check (do not include blank checks)
☐ Bank letter confirming account/routing
☐ Micro-deposit verification (if available)
☐ Other verification: [Describe]


5. Changes to Banking Information (Anti-Fraud)

5.1 Any changes to banking details must be submitted in writing using this form and verified by [Paying Company] through a separate callback or verification step.
5.2 Change requests sent only by email may be rejected for security reasons.


6. Cancellation / Revocation

6.1 Vendor may revoke this authorization by providing written notice at least [__] business days before the next scheduled payment, unless otherwise required.


7. Data Handling (Optional)

7.1 Banking information will be used only for vendor payments, stored securely, and access will be limited to authorized personnel.


Signatures

Vendor Authorized Representative: [Full Name]
Title: [Title]
Date: [Date]
Signature: ___________________________

For Paying Company (Optional): [Name]
Title: [Title]
Date: [Date]
Signature: ___________________________

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Easy-to-understand jargon

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Vendor ACH Authorization / Vendor Direct Deposit Form Template

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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.

VENDOR ACH AUTHORIZATION / VENDOR DIRECT DEPOSIT FORM TEMPLATE FAQ


What is a vendor ACH authorization form?

A Vendor ACH Authorization (Direct Deposit) Form is a document a vendor completes to authorize a company to pay them via ACH transfer (direct deposit). It collects banking details, contact information, and confirmation that the vendor is authorized to provide the account information.


Why should you have a written authorization?

A written authorization helps prevent payment fraud, confirms where funds should be sent, and provides a record if banking information changes. This template also includes a “change of banking details” section to reduce spoofing risks.


What information should be included?

Include: vendor business details, bank name, routing number and account number (handled securely), account type, account holder name, payment contact, and a signature. This template also includes an optional voided check / bank letter verification section.


How do you protect bank details?

Use secure collection methods, restrict access, and avoid emailing full account numbers when possible. This template includes a short security note and encourages using secure upload methods.


Is this the same as a W-9 or tax form?

No. A W-9 (US) or other tax form is separate. This template includes an optional checkbox to collect tax forms alongside banking details.


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