SAMPLE AUTHORIZATION FOR DIRECT DEPOSIT VIA ACH (ACH CREDIT)

SAMPLE AUTHORIZATION FOR
DIRECT DEPOSIT VIA ACH (ACH CREDIT)
CONSUMER AUTHORIZATION FOR DIRECT DEPOSIT VIA ACH (ACH CREDITS)
Direct Deposit via ACH is the deposit of funds to a consumer’s account, for example, payroll, employee
expense reimbursement, government benefits, tax and other refunds, annuities, and interest payments.
[Company Name]
I (we) hereby authorize __________________
(“COMPANY”) to electronically credit my (our) account
(and, if necessary, to electronically debit my (our) account to correct erroneous credits1) as follows:
 Checking Account /  Savings Account (select one) at the depository financial institution named below
(“DEPOSITORY”). I (we) agree that ACH transactions I (we) authorize comply with all applicable law.
Depository Name______________________________
Routing Number________________ Account Number________________________________________
Name(s) on the Account________________________________________________________________
Amount of credit(s) or method of determining amount of credit(s)________________________________ Date(s) and/or frequency of credit(s)_______________________________________________________
I (we) understand that this authorization will remain in full force and effect until I (we) notify COMPANY
[insert manner of revocation, i.e., in writing, by phone, location, address, etc.] that I (we) wish to revoke this
authorization. I (we) understand that COMPANY requires at least [X days/weeks] prior notice in order to
cancel this authorization.2
Name(s)______________________________________________________________________________
(Please Print)
Date__________ Signature(s)___________________________________________________________
The NACHA Operating Rules do not require the consumer’s express authorization to initiate Reversing Entries to correct erroneous
transactions. However, Originators should consider obtaining express authorization of debits or credits to correct errors.
2
Written credit authorizations must provide that the Receiver may revoke the authorization only by notifying the Originator in the time
and manner stated in the authorization. The reference to notification should be filled with a statement of the time and manner that
notification must be given in order to provide company a reasonable opportunity to act on it (e.g., “In writing by mail to 100 Main
Street, Anytown, NY that is received at least three (3) days prior to the proposed effective date of the termination of authorization”).
1
© 2012 NACHA — The Electronic Payments Association. Used with permission.
This form is illustrative only and is not intended to provide legal advice or any other professional service.
NACHA does not guarantee or make any representations or warranties of any kind.
Direct Deposit via ACH Implementation Checklist
The checklist below will help you seamlessly plan, implement, and execute your Direct Deposit via ACH plan. Visit
www.electronicpayments.org to learn more, or contact your financial institution or payroll provider.
Internal Planning and Communication
q Engage senior staff, managers, and influencers to solicit support.
q Develop a Direct Deposit via ACH authorization form, using the sample authorization form on
electronicpayments.org as a guide.
q Recommend that your company offers split deposits to encourage employees to build savings automatically with
Direct Deposit via ACH.
q Designate internal Direct Deposit via ACH contact personnel.
q Decide cut-off date for initial sign-ups and timing for subsequent sign-ups.
q Create promotional materials, i.e., memos, letters, website/Intranet site messages, or brochures to announce the
program.
q Announce senior staff commitment and enrollment.
External Promotion and Customer Education
q Meet with employees, retirees, and shareholders, to explain Direct Deposit via ACH. Distribute promotional
materials and authorization forms, which are available on electronicpayments.org. Invite your financial institution
or payroll provider to take part in the meeting and plan the agenda.
q Promote Direct Deposit via ACH in company materials, including newsletters, memos, Intranet sites, bulletin
boards, and other communications channels.
q Encourage new hires to sign-up at employment and retirees to sign-up at retirement.
q Include Direct Deposit via ACH statement stuffers with paychecks.
Processing Procedures
q Work with your financial institution or payroll provider to implement and test its secure service for initiating Direct
Deposit via ACH payment instructions, and review all appropriate sound business practices.
q Work with your financial institution or payroll provider to implement electronic or paper-based options for reporting
gross, deduction, and net amount details to employees.
q Compare your annual payroll schedule with your financial institution or payroll provider’s processing schedule.
Adjust as necessary for bank holidays and non-processing days.
q Collect employee authorization forms and load employee account number and institution routing transit number
information into the secure service software.
q Initiate test transactions (pre-notifications) through the secure service to ensure that the information is properly set
up, and promptly correct any errors that your financial institution or payroll provider reports to you.
q Create live Direct Deposit via ACH payment instructions, and send the file to your financial institution or payroll
provider in conformance with its processing schedule.
q First Direct Deposit via ACH transactions processed electronically.
q Funds are debited from your account and credited to employees’ accounts on payday.
© 2012 NACHA—The Electronic Payments Association. All rights reserved.
www.electronicpayments.org
Direct Deposit via ACH Fact Sheet
“Direct Deposit via ACH” is the deposit of funds for payroll, employee expense reimbursement,
government benefits, tax and other refunds, and annuities and interest payments. It includes any ACH
credit payment from a business or government to a consumer.
Direct Deposit via ACH is easy to set up and easy to use. Plus, it’s convenient, safe, and gives
employees access to their money the morning of payday.
Easy, Secure, and Convenient
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On time, every time
Saves employees trips to their bank or credit union
Transfers money securely and directly to employees’ checking or savings accounts
Works even when employees are away from home
Gives employees quick access to their money
Eliminates the risk of lost or stolen checks
Enables employees to avoid other fees
Helps protect the environment
Direct Deposit via ACH is simple, safe, smart, and green.
Simple, Safe, Smart, and Green
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Employees don't have to go to their bank or credit union to deposit their money.
Employees pay no extra fees to receive their money.
Employees can build savings by splitting their deposits between accounts.
Direct Deposit via ACH payments never get lost.
Direct Deposit via ACH reduces the risk of identity theft.
Employees’ money is protected by federal consumer protection regulation and banking rules.
Electronic payments help protect the environment by reducing waste.
Saves Money
Direct Deposit via ACH helps companies of all sizes save money. Download the Direct Deposit via
ACH calculator, available at electronicpayments.org, to learn how much you can save by
switching to Direct Deposit via ACH.
Visit www.electronicpayments.org to learn more, or contact your financial institution or payroll provider.
© 2012 NACHA—The Electronic Payments Association. All rights reserved.
www.electronicpayments.org
Payroll Solution Providers
As found on NACHA’s ePayments Marketplace
ACH Tools
406 Garden Brook Trail Hoover, AL 35244
www.achtools.com
727-488-0410 Phone
support@achtools.com
ADP Automatic Data Processing, Inc.
1 ADP Boulevard Roseland, NJ 07068
www.adp.com
800-225-5237 Phone
973-349-5771 Fax
webmarketing@adp.com
Cachet Financial Services
750 E. Green Street Suite 315 Pasadena, CA 91101
www.cachetbanq.com
626 578-9400 Phone
626-568-3938 Fax
info@cachetbanq.com
Coastal Software
PO Box 872106 Vancouver, WA 98687-2106
www.coastalsoftware.com
360-891-6174 Phone
derykm@coastalsoftware.com
Heartland Payment Systems
90 Nassau Street Princeton, NJ 08542
www.heartlandpaymentsystems.com
888-798-3131 Phone
609-683-3815 Fax
Moriah.Murphy@e-ps.com
© 2013 NACHA —The Electronic Payments Association. All rights reserved.
www.electronicpayments.org
Integrity Payment Systems
1700 Higgins Road Suite 690 Des Plaines, IL 60018-6411
www.integritypaymentsystems.com
888-477-4500 Phone
847-720-1110 Fax
SunTrust Treasury & Payment Solutions
303 Peachtree Street 26th Floor Atlanta, GA 30308
www.suntrust.com
800-786-8787 Phone
404-813-1293 Fax
dana.n.wysinger@SunTrust.com
SurePayroll
2350 Ravine Way Suite 100 Glenview, IL 60025
www.surepayroll.com/businesspartners
877-954-7873 Phone
bizdev@surepayroll.com
The Small Business Authority powered by Newtek Business Services
212 W. 35th Street 2nd Floor New York, NY 10001
www.thesba.com
855-284-3722 Phone
212-643-1006 Fax
Treasury Software Corporation
3420 Pump Road Suite 109, VA 23233
www.treasurysoftware.com
866-226-5732 Phone
salesfm@treasurysoftware.com
Trusteer, Inc.
545 Boylston Street 5th Floor Boston, MA 02116
www.trusteer.com
617-606-7755 Phone
617-606-7756 Fax
Kristin.grimes@trusteer.com
AmCheck Inc.
5030 E Sunrise Drive Phoenix, AZ 85044
480-763-5900 Phone
BB&T
200 W 2nd St. Winston-Salem, NC 27101
703-549-1883 Phone
703-549-6946 Fax
© 2013 NACHA —The Electronic Payments Association. All rights reserved.
www.electronicpayments.org
BNY Mellon
One Wall Street New York, NY 10286
Cachet Financial Services
750 E. Greeen St Suite 315 Pasadena, CA 91101
626-578-9400 Phone
626-568-3938 Fax
Ceridian Corporation
3311 East Old Shakopee Rd. Minneapolis, MN 55425
800-729-7655 Phone
Ceridian Stored Value Solutions
101 Bullitt Lane Suite 305 Louisville, KY 40222
502-326-4600 Phone
Charles J. Read, Inc
816 Office Park Circle Lewisville, TX 75057
972-353-0000 Phone
972-353-0050 Fax
CreditCardSupplies.net
PO Box9248 Knoxville, TN 37940
865-573-4749 Phone
Cynergy Data LLC
3030 47th Ave., Suite 900 Long Island City, NY 11101
347-327-3273 Phone
Elan Financial Services
225 West Station Square Drive Suite 620 EX-PA SS6 Pittsburgh, PA 15219
412-552-2527 Phone
412-552-2290 Fax
Fi-Soft LLC
8765 Spring Cypress, Ste. L-146 Spring, TX 77379
281-401-8103 Phone
incentivelogic
7600 E Redfield, Suite 140 Scottsdale, AZ 85260
480-776-0800 Phone
Merchant Data Systems
1688 Meridian Ave., Suite 802 Miami Beach, FL 33139
800-249-6377 Phone
© 2013 NACHA —The Electronic Payments Association. All rights reserved.
www.electronicpayments.org
Obopay
350 Marine Pkwy Suite 100 Redwood City, CA 94065
650-264-2000 Phone
Payarct Payroll
36 North Salem Schaumburg, IL 60194
888-617-5611 Phone
Piracle, Inc.
556 Confluence Ave Murray, UT 84123
800-621-5720 ext.356 Phone
Rev Worldwide
Austin, TX 78703
512-531-1170 Phone
Sage Payment Solutions
1750 Old Meadow Road Suite 300 Mclean, VA 22102
703-848-2980 Phone
Sovereign Bank
1031 Adams Dr. Colorado Springs, CO 80904
631-531-0601 Phone
303-967-2366 Fax
This resource is not an exhaustive list of payroll solution providers, and is solely intended for education
and informational purposes only. NACHA – The Electronic Payments Association does not endorse the
use of any particular provider or application of any particular service or product. This list was generated
from NACHA’s ePayments Marketplace, an industry resource that provides information about vendors
offering electronic payments services. For more information, please visit NACHA’s ePayments
Marketplace.
© 2013 NACHA —The Electronic Payments Association. All rights reserved.
www.electronicpayments.org