ACH Authorization Form

DIRECT DEPOSIT/ACH ELECTONIC FUNDS TRANSFER
AUTHORIZATION AGREEMENT

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I (we) hereby authorize Florida Youth Soccer Association, Inc. to initiate credit/deposit to my (our) account indicated below, and the depository institution below to credit the same to such account.

I (we) hereby request a change to my (our) existing direct deposit as indicated below.

Note: Please allow 15 business days for ACH processing to become effective.

Individual/Vendor Information - Please fill out the information below. Name submitted must be on the account.

Name on Account *

Social Security or Tax ID Number *

Mailing Address *

Phone Number *

Depository Information - Please fill out the information below.

Bank Name: *

Checking Routing Number *

Checking Account Number *

This authorization is to remain in full force and effect until the company has received written notification from me (or either of us) to discontinue direct deposit. Please allow 15 business days for processing of ACH discontinuation.

Please upload a direct deposit form from your bank or a screenshot of your routing/account number (voided check):

File Upload *

Please upload a W9 below. If you currently have a W9 on file with FYSA please confirm with Michelle Cook at finance@fysa.com.

A copy can be found HERE

File Upload

Signature of Primary Account Holder *

Date *

*All information on this page is secure via our website protocols.

We do not store your credit card information.*

ACH Authorization Form

DIRECT DEPOSIT/ACH ELECTONIC FUNDS TRANSFER AUTHORIZATION AGREEMENT

DIRECT DEPOSIT/ACH ELECTONIC FUNDS TRANSFER
AUTHORIZATION AGREEMENT