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Bank Change Form

This document is a bank account change request form for ACH debits and credits. It requests the merchant's current banking information as well as the new banking information they wish to use, and notes that a voided check must be faxed along with the completed form. The form must be signed by an authorized principal and includes contact information for questions.

Uploaded by

Allen Hartwig
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© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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23 views

Bank Change Form

This document is a bank account change request form for ACH debits and credits. It requests the merchant's current banking information as well as the new banking information they wish to use, and notes that a voided check must be faxed along with the completed form. The form must be signed by an authorized principal and includes contact information for questions.

Uploaded by

Allen Hartwig
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Toll-Free 800-546-1997

Fax 877-734-6506
[email protected]

BANK ACCOUNT FOR ACH DEBITS/CREDITS


CHANGE REQUEST FORM
IMPORTANT - PLEASE READ BEFORE PROCEEDING:
ALL INFORMATION LISTED IS REQUIRED AND MUST BE COMPLETED.
PLEASE FAX THIS REQUEST FORM AND A VOIDED CHECK TO DATA PROCESSING AT (877) 734-6506.
THIS REQUEST WILL NOT BE EFFECTIVE UNTIL THE REQUIRED DOCUMENTS ARE PROVIDED AND APPROVED.
Thank you for your cooperation.

Merchant Name: ______________________

Merchant Number: ______________________

IMPORTANT: If the merchant name on the check is different than the current name on the merchant account, the request will not be
processed without a completed Business Name Change form. Please contact Merchant Services at (877) 734-6506 or via email to
[email protected] for a copy of this form.

>>

Old Banking Information:

Bank Name:

____________________________________________________________________________

Bank Phone Number:

_____________________________________________________________________

Transit Routing Number / ABA Number:

_______________________________________________________

Account Number: _________________________________________________________________________

>>

New Banking Information: (Must be a checking account)

Bank Name:

____________________________________________________________________________

Bank Phone Number:

_____________________________________________________________________

Transit Routing Number / ABA Number:

_______________________________________________________

Account Number: _________________________________________________________________________

Signature of Authorized Principal:

(as specified on the Merchant Application/Agreement)

Print Name: __________________

____________________________

Date:____________________

Phone: __________________ Email Address:___________________

MerchantPlus LLC - 29 Broadway, 30th Floor, New York, NY 10006


MerchantPlus is a registered ISO/MSP of Wells Fargo Bank, N.A., Walnut Creek, CA
Bank is FDIC Insured

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