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14 views

bac

Uploaded by

starlightss1987
Copyright
© © All Rights Reserved
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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Banking Account Change Request

Provide your business information


Effective Date Merchant ID Number Phone Number

Doing Business As Name Legal Business Name

Enter your checking account numbers1


Deposit Account Withdrawal Account Same as deposit account
Where we will deposit your funds. Where we will withdraw your fees.

Provide your current checking account numbers* Provide your current checking account numbers*
Routing Number Account Number Routing Number Account Number

Provide your new checking account numbers* Provide your new checking account numbers*
Routing Number Account Number Routing Number Account Number

1
Only checking accounts can be used. *See next page for instructions on how to locate routing and account numbers.

Select the supporting document you will provide*


Check the box next to the supporting documentation you are supplying and attach it as a second page to this document.

Voided Check Bank Letter


*See next page for examples of documentation requirements.

Acknowledgement
On behalf of the merchant identified above (the “Merchant”), I request that the bank account(s) (the settlement account(s)) associated
with the above Merchant ID be updated to reflect the new checking account(s) indicated above (the “New Account(s)”). I represent that I
am authorized to submit this change on behalf of the Merchant, and that the New Account(s) belong(s) to Merchant. I authorize you to
make any debits or credits to the New Account(s) as may be permitted under my merchant processing relationship with you. I
understand that, if I accept payment types other than Visa, MasterCard and Discover (such as the American Express Card and TeleCheck
Services), I am also responsible for contacting the card organizations or companies governing those cards to notify them of this change.

Legal Signer’s Signature Title

Legal Signer’s Printed Name Date

Take the next steps to complete the update


 After you complete the form, return it to fax number or reply to the email you received from
[email protected]. If you do not reply to this email directly, the information will not be sent
securely.
 After we receive the form, your request should be completed within 24-48 business hours.
 Keep your existing settlement account open until you confirm funds are deposited into the new account.
 If you are receiving statements directly from a third party providers (e.g. American Express) you must contact them directly to
change your account information.
Revised 09/28/17
*Voided Check Requirements
Starter checks may not be used.

DBA or Legal Name


The name and address Check Number
must match the account Check number must be
information on file. on the top right and
bottom of the check.

VOID
ACH Routing/Transit Number

Routing Number Account Number


The routing number The account number
(ABA) must be on the (DDA) must be on the
bottom of the check. bottom of the check.

**Bank Letter Requirements


The bank letter should always be typed.

Bank Letterhead
DBA or Legal Name The letter must be
printed on official
The doing business as or bank letterhead.
legal name related to the
Merchant ID number should
be included in the letter.

Banker Signature Routing & Account Number


The banker should sign the
letter. Ensure complete ABA (routing #)
and DDA (account #) is included.

Contact Information
The bank officer’s name
and phone number should
be included in the letter.

Revised 09/28/17

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