DISCLAIMER: ELECTRONIC MAIL SENT THROUGH THE INTERNET CANNOT BE CONSIDERED SECURE AND COULD BE INTERCEPTED BY A THIRD PARTY. USE OF ELECTRONIC MAIL
TO PROVIDE INFORMATION IS COMPLETELY VOLUNTARY AND THE SOLE RISK OF THE SENDER. CARGILL MAKES NO WARRANTY OR GUARANTEE THAT YOUR EMAIL
TRANSMISSION WILL BE SECURE, UNINTERRUPTED OR ERROR-FREE AND CARGILL DISCLAIMS ALL WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, REGARDING SUCH
ELECTRONIC MAIL USE.
ACH ENROLLMENT/CHANGE AUTHORIZATION FORM
This is to notify Cargill, Incorporated and/or one or more of its subsidiaries and affiliates (herein collectively called CARGILL) of enrollment or change in EFT/ACH banking
instructions for the Company (name stated below) herein referred to as Company. CARGILL desires the flexibility to make payments for such goods and/or services by
electronic funds transfers through the Automated Clearing House (ACH) system, and Company agrees to grant such flexibility. Therefore Company (1) authorizes CARGILL
to make payment for goods and services by ACH, (2) certifies that it has selected the following depository institution, and (3) directs that all such electronic funds transfers be
made via the ACH CCD transaction format. If the CTX transaction format is preferred, please specify such and provide a CTX contact. In the event of any duplicate
payment, overpayment, fraudulent payment or payment made in error, the receiving party will immediately return such payment upon confirming the occurrence of any of the
foregoing.
NEW BANK INFORMATION (US BANKS ONLY)
Bank Name
Street Address
City, State & Zip
Bank Contact Name
Phone and Fax for Bank Contact_________________________________
Email address for Bank Contact
New ABA/Routing Number
Bank Account Number
Account Type DA-Demand/Checking Acct SG-Savings Acct
CURRENT BANK INFORMATION (if change request)
Bank Name
Street Address
City, State & Zip
Current ABA/Routing Number
Bank Account Number
Account Type DA-Demand/Checking Acct SG-Savings Acct
Company will provide Cargill 30 days written advance notice of any
changes in its depository institution or payment instructions. When
properly executed this Authorization may become effective up to
14 days after Cargill’s receipt.
Changes to current ACH may take up to 14 business days to become
effective. In the interim, payments should be:
___Sent to old acct ___ Sent via check ___ Held until new acct effective
Remittance details are available by fax or email, please choose one
option below.
Fax - Provide attention name on fax notification and fax number
Email – PDF format Email – Excel format
(Email addresses cannot exceed 40 characters)
(Email addresses cannot exceed 40 characters)
Signature Authorizing ACH Enrollment/Change
Title and Date
Effective Date of New Bank Activity
COMPANY INFORMATION
Company Name
Remit Address
City, State & Zip+4
Company Contact Name (Person Completing This Form)
Phone and Fax for Contact_____________________________________
Email address for Contact
Cargill Use Only
Cargill BU/Location: JDE AB#
JDE Company Name (Exact From JDE)
Data Creator (Printed Name and Phone)
Data Creator Signature and Date
Data Verifier (Printed Name and Phone)
Data Verifier Signature and Date
Form of Data Verification Please check type and provide information.
Via Phone: Provide phone number and name of person interviewed
and relationship to person completing the ACH request.
Via E-mail: Attach copy of email correspondence to this request.
Data Approver (Printed Name and Phone)
Data Approver Signature and Date
Mail/email/fax form to:
Your local Cargill office
