Authorization Agreement for Direct Deposits Via ACH

ACH Credits

Instructions

Complete the Authorization Agreement for Direct Deposits Via ACH (ACH Credits) form to request payment of expense reimbursements (for UH Foundation and UH/RCUH employees) and vendor invoices by ACH method. Please allow approximately one week for the account to be setup and activated before the first ACH payment request is submitted.

1. Select the type of form being submitted
   1. New: Request a new ACH payment account
   2. Change Information: Modify information on an existing ACH account
   3. Cancel: Cancel an existing ACH account
2. Provide the vendor’s name, contact name and an email address to receive payment confirmations.
3. Provide information on the financial institution to which the payment should be made.
   1. Depository Name: Provide the name of your bank or financial institution (must be domestic (U.S.) bank).
   2. Account Type: Select one option, either checking or savings account
   3. Transit/Routing Number: This is the bank’s routing number, usually found at the bottom of your check. You may also search for your financial institution on the ABA routing number website (https://routingnumber.aba.com/Search1.aspx). Type your bank's name and location, and it will provide the routing number for your branch.
   4. Account Name: Enter the name on the account being debited if different from the vendor’s name.
   5. Account Number: Enter the bank account number without punctuation.
      

4. Signatures: The form should be signed and dated by at least one authorized signer on the account. Provide a second signature if this is required by your company’s policy. Esignatures are accepted if initiated through DocuSign or Adobe Sign with accompanying certificate of completion.
5. Fully executed forms may be submitted to UH Foundation through our secure file sharing site: https://www.uhfoundation.org/payment-request-documents-upload
6. Questions about the form will be directed to the contact email address. Assistance in completing the form may be directed to AP Supervisor, Kim Dilda, at kimberly.dilda@uhfoundation.org.