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BANK ACCOUNT NUMBER FOR ACH DEBITS…
Tags: aba number, banking information, change request form, checking account, cooperation, customer service department, debits credits, information bank, merchant application, merchant name, merchant number, phone number, routing number, signature,Pages: 1
Language: english
Created: Thu May 20 14:52:16 2004
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BANK ACCOUNT NUMBER FOR ACH
DEBITS/CREDITS
CHANGE REQUEST FORM
IMPORTANT - PLEASE READ BEFORE PROCEEDING:
ALL INFORMATION LISTED IS REQUIRED AND MUST BE COMPLETED.
PLEASE FAX THIS REQUEST FORM AND THE VOIDED CHECK TO
CUSTOMER SERVICE AT 425-969-2945.
THIS REQUEST WILL NOT BE EFFECTIVE UNTIL THE SIGNATURE HAS BEEN
VERIFIED BY CUSTOMER SERVICE.
Thank you for your cooperation.
Merchant Name: _____________________________________________________
Merchant Number: ___________________________________________________
Old Banking Information:
__________________________________________ ________________________
Bank Name Bank Phone Number
_______________________________________ ________________________
Transit Routing Number / ABA Number Account Number
New Banking Information: (Must be a checking account)
__________________________________________ ________________________
Bank Name Bank Phone Number
_______________________________________ ________________________
Transit Routing Number / ABA Number Account Number
_________________________________________________________ ___________
Signature of Authorized Principal Date
(as specified on the Merchant Application/Agreement)
If you should have any questions, please contact our Customer Service department at
(800) 675-6573 or email us at support@appliedmerchant.com
A $25.00 processing fee will be charged to the new checking account.