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Void Check Information Form

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Void Check Information Form

Payor (Company Requesting Information)

Payee / Account Holder Information

Bank Account Information

Account Type:

Verification: I have attached a voided check or deposit slip to verify the above account information.

Deposit Allocation and Effective Date

Desired Effective Date:

Authorization and Certification

By signing below, the Account Holder certifies that the information provided on this form is true and correct, and that the attached voided check accurately corresponds to the account designated for electronic payments. The Account Holder authorizes the Payor named above to initiate Automated Clearing House (ACH) credit entries to the account identified above and, if necessary to correct erroneous entries, debit entries or adjustments for amounts credited in error.

The Account Holder represents that they are an authorized signer on the designated account. This authorization will remain in effect until the Payor receives written notification of its termination at least thirty (30) days prior to the requested termination date. The Payor is entitled to rely upon the account and routing numbers supplied by the Account Holder and will not be liable for failed or rejected transfers resulting from inaccurate information.

The Account Holder agrees to indemnify and hold harmless the Payor from any claims, damages, losses or expenses arising from incorrect account information provided by the Account Holder or from the Account Holder's failure to notify the Payor of changes in account status. The Payor retains the right to require a new voided check or additional documentation to verify account ownership prior to processing payments.

Acknowledgment

The Account Holder acknowledges that submission of a voided check is required for verification when requested, and that providing a photocopy or digital image of a voided check constitutes compliance with this requirement.

If this form is being completed on behalf of a legal entity, the signer affirms that they have the authority to bind the entity to this authorization.

Account Holder Name:

Signature:

Date:

Title (if signing for an entity):

Contact Phone:

Contact Email:

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What the Void Check Information Form Is and when it’s used

The Void Check Information Form collects bank routing and account data by asking the account holder to attach or endorse a voided check and provide authorization for ACH or direct deposit setup. It typically captures the routing transit number (ABA), account number, account holder name, account type, and a signed authorization. Organizations use this form to set up payroll deposits, vendor ACH payments, recurring benefits disbursements, or refunds while ensuring the payer has correct, verifiable bank details and written authorization to initiate electronic credit or debit entries.

Why this form matters and its legal foundation

A completed Void Check Information Form reduces payment errors, supports faster ACH enrollment, and documents consent for electronic transfers. Electronic execution and retention are valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and reproducible records are met.

Why this form matters and its legal foundation

Typical users and when they complete this form

Organizations and individuals use the Void Check Information Form to verify bank details and obtain written ACH authorization prior to initiating electronic transfers.

  • Payroll and HR teams setting up direct deposit for employees and contractors.
  • Accounting departments and AP teams enrolling vendor payees for ACH payments.
  • Benefits administrators and financial services firms collecting bank details for refunds or recurring disbursements.

Use depends on the payer’s internal controls; some payers require a physical voided check, others accept a scanned image or bank letter combined with the signed form.

Step-by-step: completing a Void Check Information Form

Follow these sequential steps to collect valid bank information and authorization for ACH or direct deposit setup.

  • 01
    Collect details: Request routing number, account number, and account holder name.
  • 02
    Get a voided check: Ask for a clear voided check image or attach a bank letter.
  • 03
    Obtain authorization: Have the account holder sign and date the authorization section.
  • 04
    Verify and enroll: Confirm numbers via micro-deposits or bank verification before live payments.

Essential data elements on the form

Routing Number: Nine-digit ABA
Account Number: Full account ID
Account Type: Checking or Savings
Account Holder: Legal name
Voided Check: Scanned image
Signed Authorization: Hand or e-sign

Consequences and financial risks of errors

Failed ACH: Bank rejects payment
Payment Delay: Payroll or vendor late
Fraud Exposure: Unauthorized debits risk
Backup Withholding: 24% tax withholding
Reconciliation Cost: Manual corrections required
Bank Fees: Returned-item fees

Common mistakes to avoid when preparing this form

  • Submitting a blurred or cropped voided check image that omits the MICR line, preventing routing and account number verification.
  • Entering an incorrect routing or account number due to transposed digits; small typos often cause rejected ACH or misapplied payments.
  • Using a different name than the bank account title; mismatched names can trigger manual review or require additional documentation.
  • Failing to obtain clear written authorization; verbal consent alone is insufficient under most payer controls and audit requirements.

Real-world examples of how organizations use this form

These short examples show common scenarios where a Void Check Information Form ensures accurate ACH enrollment and secure payment handling.

Optica Ventures — Vendor Payments

Optica Ventures standardized a vendor onboarding packet that included a voided check form for ACH setup.

  • The form eliminated manual calls to verify bank details.
  • "The interface is simple and easy-to-use for our team; more importantly, it is just as easy for our customers."

Martin Properties — Tenant Deposits

A property manager required a void check form for recurring rent collection via ACH.

  • Tenants provided voided checks and signed authorization.
  • "I can process and execute all of these documents online with 100% compliance and built-in security. Whether on mobile or working offline, I can get forms back to their necessary parties efficiently."

How to customize and complete the form online

Configure the online form to capture required fields, attach voided check images, and route for approval using conditional rules.

Field | Configuration Required | Validate format
Routing Number Field Numeric only, 9 digits
Account Number Field Allow 6–17 digits
Attachment Field Accept PDF, JPG, PNG
Signature Field Require dated signature

Digital signing and secure submission options

Choose an eSignature platform that supports file attachments, audit trails, and required authentication.

  • Integrations: Salesforce, NetSuite, Google Workspace
  • Formats: PDF, DOCX, JPEG accepted
  • Authentication: Email, SMS code, KBA

Where to send the completed form and how processing works

Typical routing: collection, verification, bank enrollment, and activation. Clarify required approvers and verification steps before live payments begin.

  • Submit: Account holder uploads form and voided check
  • Verify: Finance or payroll validates account data
  • Enroll: Processor performs micro-deposit or bank verification
  • Activate: Payments enabled after verification

Typical timelines and processing expectations

Expect internal and external lead times for verification and first live transactions; plan enrollments ahead of payment cycles to avoid missed deposits.

Form submission timing:

Submit before payroll cutoff for the intended pay cycle

Bank verification:

Micro-deposits or verification typically take 1–3 business days

Processor lead time:

Enrollment may require 2–5 business days for bulk changes

Change effective date:

Allow one full pay period after verification

Retention timing:

Store the signed form per company retention schedule

Key milestones from collection to live payments

A concise milestone sequence helps teams track progress and reduce payment interruptions.

01

Collection

Account holder provides voided check and signed form

02

Initial Verification

Finance confirms routing and account numbers

03

Bank Verification

Micro-deposits or instant verification complete

04

Activation

Account is cleared for ACH transactions

eSignature vendor pricing and feature comparison for document workflows

Compare starting price and core capabilities across common eSignature vendors. signNow is listed first per comparison conventions.

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Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
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Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently asked questions about the Void Check Information Form

Answers to common questions about format, verification, digital signing, and correcting errors.


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