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AUTHORIZATION OF ONETIME ACH DEBIT TRANSFER OF FUNDS
flagstar.com
Rev 9/15 • Member FDIC
Flagstar Bank makes it easy for you to deposit money into your account. Use this form to authorize
Flagstar Bank to initiate a FREE one-time ACH (Automated Clearing House) debit transfer from your
existing financial institution account to credit your Flagstar Bank account.
Customer Information
Last Name: First Name: Middle Initial:
Debit Account Information
Other Financial Institution Name:
Account Number:
Routing Number:
Account Type:
q Checking q Savings
Account Classification:
q Consumer Account q Business Account
Amount of Authorized Debit: $
Credit Account Information
Flagstar Bank Account Number: #
Account Type:
q Checking q Money Market q Savings q CD Account
Customer Authorization
I acknowledge that I am an owner of (or authorized signer on) the above referenced account to be debited and authorize Flagstar Bank to initiate
a one-time ACH debit transfer of funds from same account for credit to the above referenced Flagstar Bank account and that the origination of the
ACH transactions to my account(s) must comply with the provisions of U.S. law.
This authorization is valid only to initiate a one-time ACH debit transfer of funds from the financial institution listed above to credit the Flagstar Bank account listed above. This authorization
cannot be applied to any other transaction(s) on the debit account listed above. ACH debit transfer of funds is available only between financial institutions located in the United States.
Signature: Date: / /
Authorization process/Sign, Date, Fax
To process your request, please sign, date and fax this completed form to Flagstar Bank’s Internet Banking department at (248) 250-5551. Please retain
this completed authorization for your records.
Your request will normally be processed within one business day from receipt. Funds from ACH transfers to your Flagstar Bank account will be available
3 to 5 business days after submission of this authorization for the ACH debit transfer.
For assistance, inquiries or to revoke this authorization, please call Flagstar Bank Internet Banking (888) 248-6423.
INTERNET ACCOUNTS ONLY
click to sign
signature
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