ACH AUTHORIZATION FORM Please enable JavaScript in your browser to complete this form.Checkboxes *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 *FirstLastSocial Security or Tax ID Number * *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *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): *Please upload a W9 below. If you currently have a W9 on file with FYSA please confirm with finance@fysa.com. *Signature of Primary Account Holder *Date / Time *DateTime*All information on this page is secure via our website protocols. We do not store your credit card information.*Submit