Authorize ACH transfers securely

Complete this form to authorize us to deposit funds into authorized account. Please don't send account details by text, email, or photo — this form encrypts them instead.

Encrypted before storage
Only staff can access
Signed, auditable consent

Your information

Full name

Business name (optional)

Phone

Street address

Apt / Suite

City

State

ZIP

Bank account

Bank name

Name on account

Account type

checking

savings

Routing number

9 digits, found on the bottom left of a check

Account number

Confirm account number

Authorization

What are you authorizing?

Debits only (pull funds)

Credits only (push funds)

Debits and credits (push and pull)

I authorize the company named on this form to initiate ACH entries to the bank account listed above, and, where applicable, to credit that account. I understand that this authorization remains in effect until I cancel it in writing, and that I may dispute any unauthorized entry with my bank. I certify that I am an authorized signer on this account.

I have read and agree to the authorization above.

Type your full name to sign

Your typed name, the date, and your IP address are recorded as your electronic signature.

Sent over TLS, encrypted at rest, never emailed.