Download ACH One (1) Time Payment Form

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Use the ACH one (1) time payment form to allow any business or institution to be able to make a charge on your bank account. This form is filled in by the consumer and either E-Mailed or Faxed back to the party being paid.

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The party paying must submit the following;

  • Account Type (checking or savings)
  • Name on Account
  • Bank Name
  • Account Number
  • Routing Number
  • Bank City and State

Download (PDF, 134KB)

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