Fillable Ach-authorization-uf CSU, Chico Authorization to Initiate ACH Debit Entries

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Ach-authorization-uf CSU, Chico Authorization to Initiate ACH Debit Entries

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The Ach-authorization-uf CSU, Chico Authorization to Initiate ACH Debit Entries form is 1 page long and contains:

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  • 7 check-boxes
  • 20 other fields

Country of origin: US
File type: PDF

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CALIFORNIA STATE UNIVERSITY, CHICO
Authorization to Initiate ACH Debit Entries
University Foundation
530-898-4488 | Zip 0155
I (We) hereby authorize California State University, Chico, University Foundation to initiate debit entries to my (our) bank
account as detailed below, and to debit the same such account monthly.
Should a transaction be returned, I (we) further authorize debiting this account for non-sufficient fund fees according to
applicable State Law. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with
the provisions of U.S. Law.
Billing Name:
Billing Address:
Telephone:
Email:
Routing #:
Account #:
Account Type: (select one)
Checking
Savings
Account Class: (select one)
Consumer
Business
Monthly Donation Amount:
$
A college/school/department/program. Please specify area and amount:
$
$
$
Other: (please specify)
$
$
$
I (We) would like to make an unrestricted gift to support the University’s greatest needs.
I understand that this authorization is to remain until California State University, Chico, University Foundation has received
written notification from me of its termination at least five (5) business days prior to the payment due date.
Signature:
Date:
(Authorized Signer for Account)
Please mail completed form with a voided check to:
University Foundation
California State University, Chico
400 West First Street
Chico, CA 95929-0999
- For Gift Processing Use Only -
Banner ID: Input Date: Processor Initials:
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Ach-authorization-uf CSU, Chico Authorization to Initiate ACH Debit Entries

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Completed 9 April 2020

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