Fillable Arkansas State Treasury ACH Transaction Authorization form

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Arkansas State Treasury ACH Transaction Authorization form

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ARKANSAS STATE TREASURY
ACH TRANSACTION AUTHORIZATION
______________________________________________________________________________________
____________________________
hereby authorizes the Arkansas State Treasury to initiate electronic
DEBIT/CREDIT TRANSACTIONS
to the below referenced account for purchases, redemptions and
payments of State Treasury Investments:
Financial Institution: _______________________________________
ABA Number: _______________________________________
Account Number: _______________________________________
Please provide a contact name, mailing address and phone number for our records:
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
AUTHORIZED BY:
___________________________________________
Name
___________________________________________
Title
___________________________________________
Signature
___________________________________________
Date
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Arkansas State Treasury ACH Transaction Authorization form

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Completed 6 May 2020

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