About this template
The ACH Client Authorization Form is an essential tool for businesses that need to set up recurring or one-time automated bank payments. By using this template, you ensure that your clients provide explicit, written consent to debit their bank accounts, which is a critical step for maintaining financial compliance and professional record-keeping. This form captures all necessary banking details, including routing and account numbers, while clearly outlining the terms of the authorization.
Designed for clarity and security, this template helps streamline your billing operations. Instead of managing paper-based authorization forms that are prone to loss or manual entry errors, you can collect all required information digitally. The form is structured to ensure that the client acknowledges the payment terms, providing you with a clear audit trail for every transaction authorized through your business.
Key features
- Standardized fields for bank routing and account numbers.
- Clear section for billing address and contact verification.
- Built-in terms and conditions acknowledgement.
- Digital signature capture for legal validation.
- Easy integration with your existing financial workflows.
Use cases
- Setting up recurring monthly subscription billing.
- Processing one-time service fee payments for contractors.
- Managing tuition or membership fee collections.
- Onboarding new clients for automated invoicing.
What this form collects
- Full Name / Company Name (Short answer)Enter the name as it appears on the bank account.
- Email Address (Short answer)We will send a confirmation receipt to this email address.
- Phone Number (Short answer)Include area code (e.g., 555-0123).
- Billing Address (Paragraph)Provide the full street address associated with the bank account.
- Bank Name (Short answer)The name of your financial institution.
- Account Type (Multiple choice)Select whether this is a personal or business account.
- Routing Number (Short answer)The 9-digit routing number found on your check.
- Account Number (Short answer)Your unique bank account number.
- Terms Acceptance (Multiple choice)By checking this box, you authorize the company to initiate debit entries to your bank account for the amounts and dates specified in your service agreement.
- Electronic Signature (Short answer)Please type your full legal name to serve as your electronic signature.
- Signer Title (Short answer)If signing on behalf of a company, please provide your job title.
- Date of Signing (Date)The date you are submitting this authorization.
FAQ
Why is an ACH authorization form necessary?
It provides legal proof that the account holder has granted you permission to initiate electronic debits from their bank account, which is required by banking regulations.
How do I ensure the security of the banking data collected?
Google Forms encrypts data in transit and at rest. Ensure you have restricted access to the responses spreadsheet to only authorized financial personnel.
Can I add my own payment terms to this template?
Yes, you can easily edit the text in the 'Terms and Conditions' section to reflect your specific business policies and legal requirements.
What should I do if a client needs to revoke their authorization?
You should maintain a separate process for clients to request revocation in writing, which you can then record alongside their original authorization form.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.