What is required for a valid authorization?

A valid ACH authorization shows the payer’s intent to allow debits or credits, includes bank routing and account numbers, and contains clear authorization language. For consumer-facing transactions, ESIGN (15 U.S.C. ch. 96) requires the consumer’s consent to electronic records and a reproducible record.

Can the request be signed electronically?

Yes. Electronic signatures are binding under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states when intent, consent, attribution, and retention are present. Certain exceptions (wills, court orders) remain ineligible for e-signature.

How should I verify the bank account?

Common verification methods include a voided check, micro-deposits, or bank-initiated verification. Use stronger verification for high-dollar transactions and document the method used in the audit trail.

What if the account information changes?

Collect a new ACH Payment Information Request and replace stored credentials. Treat the new form as a separate authorization and document the effective date and method of verification.

How long does the authorization remain valid?

Validity depends on the authorization terms. If no expiration is specified, retain evidence of ongoing consent and follow your processor’s rules; allow reasonable time for revocation to take effect before the next debit.

How can a payer revoke authorization?

Provide a clear revocation method in the form (email, written notice, online cancellation). Under Regulation E and NACHA rules, processors typically require notice before the next scheduled debit to stop further entries.

Electronic Signature
Templates
Finance
ACH Payment Information Request

ACH Payment Information Request

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

ACH PAYMENT INFORMATION REQUEST

Requesting Company (Payor)

Company Name Company Address

Contact Name

Phone

Email

Payee / Vendor Information

Payee / Vendor Name Business or Remittance Address

Remittance Contact

Phone

Remittance Email

Federal Tax ID / SSN

Bank Account Information (for ACH credits to Payee)

Bank Name:

Bank Address:

Routing (ABA) Number

Account Number

Account Name

Account Type (select all that apply) Checking Savings Other Attach Proof of Account

Attach a pre-printed voided check or a bank letter confirming account and routing numbers. File:

Payment Instructions

Type of Payment: ACH Credit (Payee receives funds) ACH Debit (Payor debits Payee's account)

Effective Date

Frequency

Amount (if fixed)

Payment Reference

Authorization and Certification

By signing below, Payee authorizes Requesting Company and its designated financial institution to initiate Automated Clearing House (ACH) credit and/or debit entries to the account specified above, and, if necessary, to initiate adjustments for any entries made in error. This authorization shall remain in effect until Requesting Company receives written notification of revocation in sufficient time to afford Requesting Company and its financial institution a reasonable opportunity to act on it, which shall be no less than thirty (30) calendar days following receipt of such notification.

Payee certifies that: (a) the information provided on this form is true and correct; (b) Payee is the owner or authorized signatory on the account referenced; (c) Payee will notify Requesting Company promptly of any changes to the account or financial institution; and (d) Payee will indemnify and hold harmless Requesting Company for any loss, claim or damage, including reasonable attorneys' fees, arising from Payee's failure to provide accurate information or timely notice of changes.

Requesting Company reserves the right to apply reasonable verification procedures prior to initiating ACH transactions and to suspend payments if information cannot be validated. In the event of returned or rejected ACH entries due to faulty instructions, Payee is responsible for all bank fees and charges associated with such returns.

Additional Terms or Notes

Representations & Acknowledgements

Payee represents that it has full authority to execute this authorization and that the person signing below is appropriately authorized. Payee acknowledges that ACH transactions are subject to the rules of the payment network, and that disputes must be resolved in accordance with those rules.

Payee Printed Name:

Title / Capacity:

Signature:

Date:

What the ACH Payment Information Request Is

An ACH Payment Information Request is a written or electronic form that collects the bank routing number, account number, account type, and payer authorization needed to initiate Automated Clearing House (ACH) debit or credit entries. It documents payer consent, payment frequency, and effective dates so payers, payees, and processors have a clear auditable record of authorization for recurring or one-time electronic transfers.

Why a Clear ACH Request Matters

A complete ACH Payment Information Request reduces payment delays, lowers chargeback risk, and creates an auditable authorization record that supports compliance with NACHA rules and consumer protection laws such as Regulation E.

Who Completes and Signs an ACH Payment Information Request

Typical signers include the paying party and an authorized company representative responsible for bank relationships and payment approvals.

Payor / Account Holder — Individual or business owner providing bank account and consent for debits/credits.
Accounts Payable / AR — Department staff who set up, verify, and reconcile ACH entries in accounting systems.
Authorized Officer — CFO or designee with corporate authority to bind the organization to payment authorizations.

Use the appropriate signer based on corporate authority: sole proprietor, authorized officer, or delegated accounts-payable staff, and record title and date with the signature.

Step-by-Step: Completing an ACH Payment Information Request

Follow these steps to collect, verify, and retain ACH authorization safely and consistently.

01

Prepare Form: Provide clear fields and authorization language.
02

Collect Bank Details: Obtain routing and account numbers from the payor.
03

Verify Account: Use voided check, micro-deposits, or prenote.
04

Store Authorization: Retain signed record and audit trail.

Typical Processing Flow for an ACH Authorization

A standardized routing of tasks ensures the authorization is collected, verified, and made available for processing and audit.

Create Request: Send the completed form to the payer.
Authenticate Signer: Confirm identity by ID, micro-deposits, or KBA.
Process Entry: Submit ACH file to originator or bank.
Archive Record: Store signed authorization and logs.

Configuring an Online ACH Authorization Workflow

Set up form fields, signer authentication, and retention rules to match your risk profile and processor requirements.

Field	Configuration
Authentication	Email + SMS code or knowledge-based verification
Remittance Field	Include invoice or customer ID for reconciliation
Return Handling	Automated alerts for ACH returns and NSF
Record Retention	Set secure retention per policy and regs

Technical Requirements for eSubmission and Integration

Configure retention, access controls, and logging to align with your compliance obligations; choose a platform with strong encryption and audit capabilities.

Integrations: Salesforce, NetSuite, Google Workspace
Supported Formats: PDF, DOCX, HTML
Authentication Options: SMS, email, or advanced KBA

Timing and Typical Deadlines to Expect

Timelines vary by bank, payment processor, and whether verification methods (micro-deposits, prenotification) are used.

Submit Before First Debit:

Provide authorization prior to the scheduled debit date to avoid failed transactions.

Bank Verification Window:

Allow 1–5 business days for verification; timing varies by bank and method.

Unauthorized Charge Claims:

Consumers often must report errors within 60 days under Regulation E (12 C.F.R. part 1005).

Backup Withholding Trigger:

Missing/incorrect TIN can trigger 24% backup withholding per IRS rules.

Record Retention Requirement:

Maintain reproductions of authorizations consistent with ESIGN record retention expectations.

Key Implementation Milestones

A clear milestone schedule reduces setup friction and ensures authorizations are verified before live processing.

01

Request Issued

Form delivered to payer for completion and signature.

02

Identity Verified

Bank details confirmed via voided check or micro-deposits.

03

Authorization Active

Effective date recorded and scheduled payments enabled.

04

Ongoing Reconciliation

Monitor debits, returns, and update records as needed.

Essential Elements to Include on a Professional ACH Request

A complete ACH Payment Information Request combines payment details, explicit consent language, and clear administrative fields to support processing and audits.

Bank Details

Routing number and account number fields with instructions to confirm using a voided check or bank statement for accuracy and reconciliation.

Account Type

Explicit selection between Checking and Savings to ensure the originator uses the correct ACH entry class and avoids bank rejections.

Authorization Language

Clear, standalone consent specifying recurring or one-time debit, amount range if applicable, and the payer’s right to revoke authorization.

Payment Schedule

Fields for frequency, amount (fixed or variable), and next scheduled debit date to support processor batching and customer notices.

Revocation Terms

Instructions on how the payer can cancel authorization and the time needed to process a revocation before the next debit.

Privacy Notice

Brief statement on how bank details will be stored and shared, and references to applicable privacy policies and BAAs where required.

Security and Compliance Basics to Display

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest

Audit Trail: Timestamped logs and IP capture

Certifications: SOC 2 Type II; ISO 27001

HIPAA: BAA available where required

ESIGN / UETA: Legal e-sign frameworks supported

21 CFR: 21 CFR Part 11 compliance options

Risks and Potential Consequences of Errors

Returned ACH Fees: Bank fees and NSF penalties

Unauthorized Debits: Chargebacks and merchant liability

Regulatory Fines: Enforcement under NACHA/Reg E

Backup Withholding: 24% withholding for incorrect TINs

Reputational Harm: Customer disputes and churn

Data Breach Risk: Exposure of bank account details

Common Mistakes to Avoid When Preparing the Request

Collecting incomplete or transposed routing/account numbers that result in failed transactions, increased return fees, and reconciliation delays.
Using vague authorization language that does not specify recurring versus one-time debits, causing disputes and chargebacks under NACHA rules.
Failing to verify signer authority for business accounts, which can invalidate the authorization and expose the organization to liability.
Retaining authorizations without adequate encryption or access controls, increasing the risk and regulatory exposure in a breach.

Practical Tips for Accurate and Efficient Setup

Adopt a repeatable process that combines verification, clear language, and secure recordkeeping to reduce errors and disputes.

Use Dual Verification

Confirm account ownership with a voided check and micro-deposits or bank-initiated verification to reduce return rates and improve reconciliation accuracy.

Standardize Authorization Text

Include explicit consent language covering frequency, amount, and revocation steps; ensure the language meets NACHA and Regulation E expectations.

Limit Data Access

Restrict access to bank details to designated roles and log all access; use encryption and MFA to reduce the risk of unauthorized exposure.

Keep Clear Audit Trails

Record timestamps, IP addresses, and verification steps; retain reproductions in searchable format to support investigations and audits.

Real-World Examples of ACH Authorization Use

Organizations use standardized ACH requests to streamline recurring payments and to preserve a clear audit trail for billing and compliance.

Martin Properties — Rent Collection

Small property manager adopted online authorizations to reduce paper handling and missed payments

Implementation focused on tenant verification and clear recurring-debit language
"I can process and execute all of these documents online with 100% compliance and built-in security." — Tim Martin, Founder

Fertility Centers of Illinois — Patient Billing

Healthcare clinic used electronic ACH authorizations with a BAA to accept patient payments securely

Emphasized patient consent and privacy controls
"The airSlate SignNow team has been exceptional, responsive, the API has been great." — John Butler, Founder

Typical Signatory Roles and Authority

Accounts Payable Manager

An operational profile responsible for setting up direct debit entries, reconciling returns, and maintaining authorization records. This role often has delegated authority to enroll customer accounts per company policy.

Authorized Officer

An executive-level signer such as a CFO or controller with legal authority to bind the organization to payment authorizations; their signature is required for corporate accounts and high-dollar arrangements.

How an ACH Payment Information Request Differs from a W-9

Compare the two documents to understand when to collect bank account details versus taxpayer identification information.

Criteria	ACH Request	W-9
Purpose	authorize bank transfers	provide taxpayer tin
Contains Bank Info
Requires TIN	optional depending on payer
Common Use	payments setup	tax reporting

eSignature Vendor Pricing and Feature Snapshot for ACH Workflows

Compare starting prices and key capabilities across vendors commonly used to collect ACH authorizations; signNow is listed first per platform comparison guidance.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No envelope cap	100 envelopes/user/year	Varies	Varies	Varies

Frequently Asked Questions About ACH Payment Information Requests

Answers to common questions about validity, verification, changes, and revocation of ACH authorizations.

Need help? Contact support

What is required for a valid authorization?
A valid ACH authorization shows the payer’s intent to allow debits or credits, includes bank routing and account numbers, and contains clear authorization language. For consumer-facing transactions, ESIGN (15 U.S.C. ch. 96) requires the consumer’s consent to electronic records and a reproducible record.
Can the request be signed electronically?
Yes. Electronic signatures are binding under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states when intent, consent, attribution, and retention are present. Certain exceptions (wills, court orders) remain ineligible for e-signature.
How should I verify the bank account?
Common verification methods include a voided check, micro-deposits, or bank-initiated verification. Use stronger verification for high-dollar transactions and document the method used in the audit trail.
What if the account information changes?
Collect a new ACH Payment Information Request and replace stored credentials. Treat the new form as a separate authorization and document the effective date and method of verification.
How long does the authorization remain valid?
Validity depends on the authorization terms. If no expiration is specified, retain evidence of ongoing consent and follow your processor’s rules; allow reasonable time for revocation to take effect before the next debit.
How can a payer revoke authorization?
Provide a clear revocation method in the form (email, written notice, online cancellation). Under Regulation E and NACHA rules, processors typically require notice before the next scheduled debit to stop further entries.

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