Fillable Ach Form (Oral Roberts University)

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Ach Form (Oral Roberts University)

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ORU Payment Enrollment Form
See page 2 for Terms and Conditions
vendors@oru.edu
Oral Roberts University
7777 S Lewis Ave, Tulsa, OK 74171
918-495-7531/7549
fax: 918-495-6985
Block 1 - INDIVIDUAL OR COMPANY INFORMATION
Individual Company
SSN# __ __ __ - __ __ - __ __ __ __ FEIN# __ __ - __ __ __ __ __ __ __
Name: _________________________________ Name: __________________________________
Address: ________________________________ Address: _________________________________
Physical Street Address (required) Physical Street Address (required)
Address: ________________________________ Address: _________________________________
Mailing Address Mailing Address
_______________________________________ ________________________________________
City, State and Zip Code
City, State and Zip Code
Phone ( __ __ __ ) __ __ __ - __ __ __ __ Phone ( __ __ __ ) __ __ __ - __ __ __ __
Block 2 - FINANCIAL BANK INSTITUTION INFORMATION
Bank Institution Name: _____________________________________________
Institution Account Number: ________________________________________
Nine-Digit Routing Number: __ __ __ __ __ __ __ __ __
Please Check Type of Account: ___ Checking ___ Savings
Block 3 - NOTIFICATION METHOD
Notification of your deposit confirmation will be sent via e-mail.
Email Address (required): _________________________________________________
Signature: ___________________________________________ Date: __________________
Printed Name: _______________________________________ Title : __________________
If you have any questions concerning ACH Transactions, please contact Mary Ellen Crosby or Reba Johnson
918-495-7531/7549 or Fax 918-495-6985.
OFFICE USE ONLY
___ Updated in Banner Processed By: ________________________________ Date: _____________
Page 1
By signing below, I acknowledge that I have read, understand and agree to the Terms and Conditions on Page 2 and that I have
the authority to execute this authorization on behalf of the vendor. This authorization is to remain in full force until Oral Roberts
University has received written notification from me of termination in such time as to afford a reasonable opportunity to act on it.
The standard for any payments made on behalf of Oral Roberts University (ORU) is through
the Federal Automated Clearing House, commonly known as ACH or direct deposit. ACH is
known to be the safest, fastest and most convenient method of payment. To enroll in the
ACH payment process, you must have a valid checking or savings account at a financial
institution that participates in ACH. Most banks and credit unions do participate in ACH.
In order to successfully carry out ORU's fiscal responsibility, the individual or company agrees:
-To the provisions of this ACH agreement;
-To provide accurate enrollment information:
-That any revised authorization will replace any previous authorization;
-That ORU may reverse any duplicate or erroneous credit entries; and
-That the authorization shall remain valid until it is terminated; revoked in writing or
by the closing of the recipient's account at the receiving financial institution.
Submission of the ACH Payment Enrollment Form authorizes ORU to electronically deposit
payments through ACH to the financial institution listed on Page 1 (Block 2) pertaining to
payments issued by the ORU Accounts Payable department for travel, refunds, and/or vendor
payments, whichever is applicable.
Your authorization shall remain in effect until advance written notice of termination is
produced to ORU. Such notice should afford ORU and the financial institution named on
Page 1 (Block 2) reasonable opportunity to take corrective action. It is your responsibility to
provide an updated ACH Payment Enrollment Form to ORU updating any changes to your
financial institution, routing and account number(s).
Notice to ORU should be addressed to: Oral Roberts University
Accounts Payable
7777 S. Lewis Avenue
Tulsa, OK 74171
or
Email forms to: vendors@oru.edu
Fax forms to: 918-495-6985
Page 2
TERMS AND CONDITIONS
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Ach Form (Oral Roberts University)

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Completed 20 July 2020

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