Can the form be signed electronically?

Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states when intent, consent, attribution, and retention are satisfied.

What verification is acceptable for bank accounts?

Accept a voided check or bank letter showing account ownership. For higher assurance, use micro-deposit verification or bank-supplied account verification services.

Is notarization required for EFT authorization?

Not normally required for routine vendor or payroll EFT authorizations. Check state rules if the authorization is combined with a power of attorney or instrument requiring notarization.

How do I revoke or change authorization?

Provide written notice per the form's revocation section. Implement an internal process to suspend payments upon receipt and confirm with the payer within the stated notice period.

What if the payer's bank info is wrong?

Incorrect routing or account numbers typically cause a returned item. Document the error, notify the payee, and resubmit the corrected authorization to avoid reoccurrence.

How long should I retain the completed form?

Retain completed authorizations for at least three years for tax and audit purposes; if PHI is involved, retain six years per 45 CFR §164.530(j).

Electronic Signature
Templates
Finance
Payment EFT Request Form

Payment EFT Request Form

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

PAYMENT EFT REQUEST FORM

Requesting Company (Payor)

Company Name Accounts Payable Contact

Phone:

Email:

Payor Address

Beneficiary (Payee / Account Holder)

Payee / Vendor Name Remittance Address

Contact:

Phone/Email:

Tax Identifier (if applicable)

Bank Account Information (Beneficiary)

Bank Name Bank Branch / Address

Routing / ABA Number:

Account Number:

Account Type (select one) Checking Savings Other

SWIFT/BIC:

IBAN:

Currency

Payment Instructions

Payment Type: One-time Recurring

Effective Date:

Frequency:

End Date (if recurring):

Payment Reference / Invoices Covered Attached Documentation

Authorization and Certification

By signing below, the Beneficiary certifies that the bank account information provided is true and correct and that the Beneficiary is the legal owner or authorized signatory for the account. The Beneficiary authorizes the Payor and the Payor's bank to credit the account identified above for payments pursuant to the payment instructions. The Beneficiary agrees to indemnify and hold harmless the Payor and its financial institution against any claims, losses, or damages arising from erroneous or fraudulent account information supplied by the Beneficiary.

The Payor authorizes its financial institution to initiate electronic credit entries and, if necessary, debit entries and adjustments for any entries made in error to the account designated by the Beneficiary. The Payor reserves the right to verify account ownership and to suspend or withhold payments until verification is complete. Notification of any change to bank account details must be provided in writing and received by the Payor at least 10 business days prior to the requested effective date of change; the Payor is not liable for transfers made in good faith to previously provided account details prior to receipt of proper notice.

This authorization remains in effect until revoked in writing by either party. Revocation will not affect payments initiated prior to receipt of revocation. This form and the obligations created hereunder shall be governed by the laws of the jurisdiction in which the Payor maintains its principal place of business. Any disputes arising from this authorization shall be resolved in accordance with such governing law.

Special Instructions / Notes

Bank Verification Consent

The Beneficiary consents to the Payor contacting the stated financial institution for the purpose of verifying account ownership and accuracy of account information. The Beneficiary acknowledges that such verification may require disclosure of information to third-party processors and authorizes such disclosure solely to effectuate payment and verification.

Beneficiary Representative Name Payor Authorization (Department / Approver)

Payor (Company) Printed Name:

By:

Date:

Payee (Account Holder) Printed Name:

By:

Date:

What the Payment EFT Request Form Is

A Payment EFT Request Form is a standardized document used to authorize electronic funds transfers (ACH/Direct Deposit) from a payer to a payee. It collects bank account and routing details, payer and payee identification, and explicit authorization language so finance teams can initiate recurring or one-time electronic payments. The form documents consent, records the payment method, and provides contact information for troubleshooting returned items or failed transfers. Organizations use it to reduce manual check processing, shorten payment cycles, and maintain an auditable record that supports reconciliation and compliance.

Why organizations use a Payment EFT Request Form

A clear EFT request form reduces payment errors, supports regulatory compliance, and creates an auditable authorization record tied to a specific payment method. It makes vendor onboarding and payroll enrollment consistent and defensible.

Who completes and relies on this form

Typical users include accounts payable teams, payroll administrators, and external vendors or contractors completing enrollment for electronic payment.

Accounts payable teams: Centralize vendor bank details and authorization, reducing bank errors and reconciliation time.
Payroll / HR administrators: Collect employee direct-deposit information and written authorization for recurring payroll deposits.
Vendors and suppliers: Provide routing/account numbers and a signature to receive invoices via ACH instead of paper checks.

Use the form when onboarding new payees, changing bank details, or switching payment methods from checks to ACH to ensure accurate, auditable instructions.

Step-by-step: complete and authorize an EFT request

Follow these steps in order to gather required information and record authorization for electronic payments.

01

Collect payee details: Obtain legal name, address, and taxpayer ID where required.
02

Capture bank information: Record ABA routing number, account number, and account type.
03

Attach supporting proof: Include a voided check or bank letter to verify account ownership.
04

Obtain signature: Get a dated signature or verified electronic consent per ESIGN/UETA.

Core elements of a professional Payment EFT Request Form

A complete form balances operational clarity with legal authorization text, verification evidence, and privacy protections to reduce downstream risk.

Payment Instructions

Clear statement of payment frequency, amount (or invoiced amounts), and start date so both parties know when and how transfers occur.

Bank Details

Dedicated, labeled fields for ABA routing number and account number plus account type to ensure accurate ACH routing and reduce return rates.

Authorization Language

Explicit consent clause authorizing ACH debits/credits, referencing the payer, payee, and consent duration to demonstrate intent and legal coverage.

Verification Attachment

Section noting required proof such as a voided check or bank letter; attachments reduce setup errors and speed bank onboarding.

Data Privacy Notice

Short statement describing how bank data will be protected and retained, aligned with HIPAA/CCPA considerations when applicable.

Change & Revocation

Instructions for how a payee may revoke or change authorization and any required notice period to prevent unauthorized transfers.

How the EFT authorization and submission process typically flows

A standard operational flow clarifies responsibilities and reduces processing time from collection to first deposit.

Form completion: Payee completes form and attaches voided check or bank verification.
Internal review: AP reviews details, verifies TIN/W-9 status, and confirms account ownership.
Bank setup: Payments team sends details to bank or payment processor for ACH origination.
First payment validation: Confirm with a test deposit or monitor initial transfer for success.

Digital workflow settings for secure e-submission

Configure a form workflow that captures consent, secures data, and routes approvals automatically.

Field	Configuration
Signature Field	Require signer's name, signature, and date
Authentication	Email plus optional SMS code for identity verification
Attachments	Allow PDF/PNG uploads for voided checks or bank letters
Routing	Route to AP reviewer then finance approver

Platform considerations for eSubmission and storage

Ensure the chosen solution preserves an immutable audit trail and meets any industry-specific compliance needs before enabling production workflows.

File formats: PDF, DOCX accepted; retain original attachments
Integrations: Connectors for ERP/Accounting systems reduce manual entry
Security: Encryption at rest and in transit is required

Security and compliance controls to include

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

Audit Trail: Timestamps, IP address, signer actions recorded

Access Controls: Role-based access and SSO recommended

HIPAA Support: BAA required for protected health information

ESIGN/UETA: Electronic signatures meet ESIGN/UETA criteria

Certifications: SOC 2 Type II and ISO 27001 supported

Key risks and potential penalties from errors

Incorrect Bank Info: Payment delays and return fees

Missing W-9: Triggers backup withholding 24%

Unauthorized Transfer: Fraud exposure and liability

Late Submission: Processing delays and missed payment windows

Data Breach: Regulatory fines and notification costs

Intentional Misreporting: Civil penalties (IRC §6721)

eSignature vendor pricing and capabilities for EFT forms

Compare core pricing and basic feature availability across common eSignature vendors; signNow is listed first per 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 (no card)	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Varies	Yes	Varies
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Varies	Varies	Varies	Varies

Frequently asked questions about Payment EFT Request Forms

Answers to common issues when collecting bank details, obtaining consent, and processing EFT authorizations.

Need help? Contact support

Can the form be signed electronically?
Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states when intent, consent, attribution, and retention are satisfied.
What verification is acceptable for bank accounts?
Accept a voided check or bank letter showing account ownership. For higher assurance, use micro-deposit verification or bank-supplied account verification services.
Is notarization required for EFT authorization?
Not normally required for routine vendor or payroll EFT authorizations. Check state rules if the authorization is combined with a power of attorney or instrument requiring notarization.
How do I revoke or change authorization?
Provide written notice per the form's revocation section. Implement an internal process to suspend payments upon receipt and confirm with the payer within the stated notice period.
What if the payer's bank info is wrong?
Incorrect routing or account numbers typically cause a returned item. Document the error, notify the payee, and resubmit the corrected authorization to avoid reoccurrence.
How long should I retain the completed form?
Retain completed authorizations for at least three years for tax and audit purposes; if PHI is involved, retain six years per 45 CFR §164.530(j).

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now