Ach Form Template UK

The ACH Form Template UK is offered in multiple formats, including PDF, Word, and Google Docs, featuring customizable and printable versions for your convenience.

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Sample

Ach Form Template UK

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PDF – 1 PDF – 2

ACH Form Template UK

1. Account Holder Information



2. Bank Information



3. ACH Authorization Details


4. Payment Amount

5. Frequency of Payment

6. Consent and Disclosure

7. Client Responsibilities

8. Bank Responsibilities

9. Revocation of Authorization

10. Signatures and Agreement

11. Declaration and Signatures



PDF

WORD

Examples

ACH Form Template UK (1)
Account Holder Information:
[Name of the Account Holder]
[Account Holder’s Address]
[Account Holder’s Phone Number]
[Account Holder’s Email]
Bank Information:
[Name of the Bank]
[Bank Address]
[Sort Code]
[Account Number]
Payment Details:
This ACH form authorizes [Name of the Company/Organization] to initiate debit entries to the specified bank account for the purpose of [Specify purpose, e.g., service payment, subscription fee].
Amount to be Debited:
The Client agrees to allow a debit of [Amount] on a recurring basis [Specify frequency, e.g., monthly, quarterly].
Authorization:
I authorize [Name of the Company/Organization] to initiate debit entries from my account as indicated above. This authorization will remain in effect until I provide written notice of cancellation to [Name of the Company/Organization] at least [Notice Period, e.g., 30 days] prior to the next debit transaction.
Governing Law:
This authorization agreement shall be governed by the laws of [Jurisdiction, e.g., England and Wales].
Signed on [Date] at [City].
Sincerely,
[Signature of the Account Holder]
[Name of the Account Holder]
ACH Form Template UK (2)
Account Holder Information:
[Name of the Account Holder]
[Account Holder’s Address]
[Account Holder’s Phone Number]
[Account Holder’s Email]
Bank Information:
[Name of the Bank]
[Bank Address]
[Sort Code]
[Account Number]
Purpose of Payment:
This ACH authorization permits [Name of the Company/Organization] to withdraw funds for [Specify purpose, e.g., product purchase, service fee] directly from the Account Holder’s bank account.
Amount and Payment Schedule:
The Account Holder agrees to the debit amount of [Amount] to be processed on [Specify schedule, e.g., the first of each month].
Cancellation:
The Account Holder may cancel this authorization by providing [Notice Period, e.g., 30 days] written notice to [Name of the Company/Organization], ensuring that any pending payments are settled.
Compliance:
This authorization complies with the applicable laws and regulations regarding ACH transactions in the UK.
Signed on [Date] at [City].
Sincerely,
[Signature of the Account Holder]
[Name of the Account Holder]

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PDF – 1 PDF – 2

Ach Form Template UK