How Do I Obtain an ACH Authorization Form?

Businesses that accept payments via a checking or savings account (i.e. ACH) are required to obtain a signed agreement that grants permission to charge or refund the bank account for a customer or business.

An ACH authorization form will typically specify the following:

  • Customer or business name
  • Routing number
  • Account number
  • Amount
  • Transaction type: one-time charge, refund or recurring
  • If recurring, start date and frequency

Rules regarding the acceptance of ACH payments are governed by Nacha. Obtaining proper ACH authorization to process an ACH payment will protect your business from disputes. Per Nacha rules, a customer can dispute an ACH transaction for the following reasons:

  • The transaction was never authorized by the account owner.
  • The transaction was processed earlier than the date specified on the authorization form.
  • The amount charged is different than the amount that was authorized. However, it is possible to obtain ACH authorization for variable amounts.

If a customer disputes an ACH transaction, and an authorization form was not obtained, then the business could lose the dispute.   

For your convenience, we've provided an example ACH authorization form. Please note, the ACH form template is intended to be updated for your specific needs.

Example ACH Authorization Form Template
There is no warranty for the example ACH authorization form provided herein. PayJunction provides access to the example ACH authorization form on this webpage "as is" without warranty of any kind, either expressed or implied, including, but not limited to, the implied warranties of merchantability and fitness for a particular purpose. The entire risk as to the quality and performance of the example ACH authorization form is with you. Should the example ACH authorization form prove defective, you assume the cost of all necessary repair or correction. It is the merchant's responsibility to ensure the example ACH authorization form meets the requirements outlined by Nacha.

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