ACH Authorization
(6/2019) (ACH)
Program Sponsor: _____________________________________________________________
Energy Finance Solutions can make payments to you either by check or through an Automated
Clearing House (ACH) transfer. ACH transfers funds directly from Energy Finance Solutions’ bank
account into your bank account through the Federal Reserve System. Transfer requests submitted by
1:00 p.m. (CST) are processed the same day, with funds available to you the next business day. Once
we process the ACH transfer, we will send you an email informing you of the amount transferred and
the invoice(s) paid.
ACH allows Energy Finance Solutions and the financial institution below to initiate electronic credit
entries and, if necessary, debit entries and/or adjustments for any credit entries which were funded
in error by Energy Finance Solutions.
If you would like Energy Finance Solutions to make payment to you via ACH transfers, please
complete this form clearly (print or type) and fax to 608-249-5788.
I, _________________________________________________, hereinafter referred to as Contractor,
hereby authorize Energy Finance Solutions to initiate credit entries, and debit entries if necessary, to
Contractor’s checking account and the depository named below, hereinafter referred to as
Depository Name: _____________________________________________________________________
Branch: _____________________________________________________________________________
City, State, Zip: _______________________________________________________________________
Transit/ABA #: _____________________________ Account #: ________________________________
Account Type (please check one): Checking Savings
Name on Account: _____________________________________________________________________
Email Address(es) for remittance advice: _________________________________________________
This authority is to remain in full force and effect until Energy Finance Solutions and Depository have
received written notification from Contractor of its termination in such time and in such manner as to
afford Energy Finance Solutions and Depository a reasonable opportunity to act on it.
Signature: ____________________________________ Date: _______________________________
Name: _______________________________________ Title ________________________________