ACH Deposit Authorization

1st Payment

9030 Red Branch Rd. Ste 250, Columbia, MD 21045 | 301-476-9003

Business Information

Business Name *

Owner / Authorized Name *

Phone *

Street Address *

City *

State *

ZIP *

Email *

Bank Account Information

Bank Name *

Account Holder Name *

Routing Number *

Account Number *

Account Type

Void Check

Click to upload void check

JPG, PNG, or PDF

Authorization Agreement

ACH DEPOSIT AUTHORIZATION

I, [Account Holder Name], hereby authorize 1st Payment to initiate recurring Automated Clearing House (ACH) credit (deposit) entries into my bank account at [Bank Name] for the purpose of depositing ATM surcharge revenue earned by [Business Name].

This authorization will remain in effect until I provide written notice of cancellation with at least 30 days' advance notice.
I understand that deposit amounts may vary based on ATM transaction volume.
I have the right to dispute any unauthorized deposit by contacting my financial institution within 60 days of the transaction.
I acknowledge that deposits will be made on a regular schedule as determined by 1st Payment.

Contact for questions or cancellation:
1st Payment
9030 Red Branch Rd. Ste 250, Columbia, MD 21045
Phone: 301-476-9003

By signing below, I confirm that I am an authorized signer on the bank account listed above and that the information provided is accurate.

Signature *

Sign above using mouse or touch

1st Payment | 301-476-9003