J.W. Pepper ACH Authorization Form (Direct Deposit)

ACH Authorization Form

For Direct Deposit
Direct Deposit is available for composers currently residing within the United States at this time.
Legal Name*
Your Legal Name or Business Name
Please complete the information below:
Transaction Type*

New ACH Set-UpChange Account NumberChange Account TypeChange Financial InstitutionCancellation
Payee Identification
Legal Name*
Full Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email Address*
[email protected]
Telephone*
Financial Institution Information
Bank Name*
Bank Address*

Street Address

Street Address Line 2

CityState

Zip Code
Bank Routing Transit Number (9 digits)*
Bank Account Number*
Account Type*

CheckingSavings
Checking Authorization for Setup, Changes or Cancellation

I authorize J.W. Pepper & Son Inc. to process payments via Automated Clearing House (ACH) deposits to the financial institution and account designated above.

I also authorize J.W. Pepper & Son Inc. to withdraw from the designated account all amounts deposited electronically in error.

If I decide to change or revoke this authorization, I recognize that I must forward such notice, via this form, to the address below and allow reasonable time for J.W. Pepper & Son Inc. to act on the termination.

I certify that I am authorized to contract for the entity receiving deposits pursuant to this agreement, and that all information provided is accurate:
Signature*

Clear
Date*

MonthDayYear
Date
Printed Name*
Title
Should be Empty:

ACH Authorization Form