ACH Authorization Form Templates for Online, Phone and Paper

Pick the template that matches how your customer pays, fill in your business name, phone number, amount and schedule, then copy, print or download the text. Everything runs in your browser; nothing you type is sent to us.

Each eCheck carries a Standard Entry Class (SEC) code that tells the banks how the customer gave permission. The form you use has to match that code. Here's the quick match, with what Authorize.Net's developer guide allowed for each code on October 13, 2026:

Not sure which code fits? Our guide to ACH SEC codes and authorization rules has a three-question picker.

[ ] By checking this box and clicking "Pay by eCheck", I authorize [Business Name] to electronically debit the bank account I entered above for a one-time payment of $[Amount] on or after [Date].
            
            I confirm that I am an authorized signer on this account.
            
            To cancel this payment before it is made, contact [Business Name] at [Phone] or [email or website].
            
            Please print or save a copy of this authorization. We will also email you a confirmation.

PHONE SCRIPT (read word for word, then record the customer's answer)
            "Today is [today's date]. My name is [your name], calling for [Business Name]. You are authorizing [Business Name] to electronically debit your [checking/savings] account, routing number [routing number], account ending in [last four digits], for a one-time payment of $[Amount] on or after [Date].
            If you want to cancel this payment, call us at [Phone] before [Date].
            Do you authorize this payment? Please say yes or no."
            [Customer answers "yes". Keep the recording, or send the written confirmation below before the payment settles.]
            
            WRITTEN CONFIRMATION (email or mail before the payment settles)
            This confirms the payment you authorized by phone on [date of call]: a one-time payment of $[Amount] on or after [Date], from your account ending in [last four digits], to [Business Name].
            Questions, or to cancel: call [Phone] or contact [email or website].

AUTHORIZATION FOR ONE-TIME ACH DEBIT
            
            I authorize [Business Name] to electronically debit my account below for a one-time payment of $[Amount] on or after [Date]. If a debit is made in error, I authorize [Business Name] to correct it with a matching credit or debit.
            To cancel this payment, I will contact [Business Name] at [Phone] before [Date].
            I confirm I am an authorized signer on this account. [Business Name] will give me a copy of this signed form.
            
            Account holder name: ______________________________
            Bank name: ______________________________
            Routing number: ______________   Account number: ______________________
            Account type:  [ ] Checking   [ ] Savings
            
            Signature: ______________________________   Date: ______________

BUSINESS ACH DEBIT AUTHORIZATION
            
            [Customer company name] ("Company") authorizes [Business Name] to electronically debit the Company's business bank account below for a one-time payment of $[Amount] on or after [Date], under the terms agreed between the Company and [Business Name]. If a debit is made in error, [Business Name] may correct it with a matching credit or debit.
            This authorization stays in effect until either party ends it in writing, giving the other reasonable time to act on it. Send notices to [Business Name] at [email or website] or [Phone].
            
            Company legal name: ______________________________
            Bank name: ______________________________
            Routing number: ______________   Account number: ______________________
            
            Authorized signer name: ______________________   Title: ______________
            Signature: ______________________________   Date: ______________

These templates are a starting point, not legal advice. Have your provider or a lawyer review them before use.

Use the WEB template when a customer types their bank details into your website, app or online invoice and clicks to pay. For online payments, the "form" is the authorization text and the button on your checkout page.

What it must include. Authorize.Net's eCheck Operating Procedures and User Guide (revision 26.03.1, 2026) says the online authorization must:

• Appear on the same page that collects the bank account details.
• Be readable and printable on screen, and clearly identifiable as an authorization.
• State the dollar amount, the date the payment will be taken and whether it's one-time or recurring.
• Make clear that clicking the button gives the authorization ("By clicking the button below, I authorize…").

For recurring online payments, add how often you'll charge, until when, and how the customer can cancel (for example, by calling a number or writing to an address). If the date or amount of a recurring payment changes, Authorize.Net's guide says to tell the customer at least 10 days ahead.

Account checks. Since March 19, 2021, Nacha has required businesses taking online consumer debits to validate a bank account the first time it's used or when the number changes. Authorize.Net says it checks the account number on WEB payments, which catches typos but doesn't confirm the money is there.

Common slip: a pre-ticked box, or authorization text hidden in your terms and conditions. The customer should take a clear action on wording they can see.

Use the TEL template when a customer gives you their bank details and permission on a phone call. TEL has two extra limits.

Who you can take TEL payments from. Authorize.Net's guide says TEL is only for customers you already have a relationship with (a written agreement, or a purchase from you in the past two years) or customers who call you. You can't cold-call someone and take a TEL payment.

How you prove it. For a one-time phone payment, Nacha's rules give you two choices, done before the payment settles:

1. Record the call, including the customer agreeing to the script, or
2. Send a written notice confirming what they agreed to.

The script (or notice) should state clearly that the customer is authorizing a debit from their bank account, plus their name, the date of the call, the date of the debit, the amount, and a phone number answered during business hours for questions. Then ask, "Is this information correct?" and get a clear yes.

Recurring phone payments. Nacha allows recurring debits authorized by phone only if you meet Regulation E's rules for preauthorized transfers, including sending the customer a copy of the authorization. But Authorize.Net's developer guide lists TEL as one-time only (no recurring, no refunds). Authorize.Net's own user guide calls TEL "one-time or recurring," so the two pages disagree. If a phone customer wants to pay on a schedule, ask your provider how to set it up. Often that means sending a signed form (PPD) or an online authorization (WEB).

Voice assistants and internet calls. Since September 17, 2021, Nacha's rules say a spoken authorization given over the internet or a wireless network (for example, a voice assistant) is a WEB payment, not TEL.

Use the PPD template when a customer signs a form to pay from their personal account, either once or on a schedule. Typical uses are memberships, tuition, payment plans and service contracts. Authorize.Net's guide says PPD authorizations must be written on paper and can't come by phone or online. Online sign-ups go through as WEB instead.

What the form should include. Authorize.Net's guide lists these elements for any eCheck authorization:

• A clear statement of the terms, including the amount
• Wording that's plainly an authorization ("I authorize [business] to charge my bank account…")
• The customer's name and signature (evidence of who they are)
• The date they signed and the date of the first debit
• The bank account number and the nine-digit routing number

For a recurring ACH authorization form, add:

• How often you'll charge, and the start and end dates (or "until cancelled")
• How the customer can cancel, and how much notice they need to give

The federal rules. Regulation E (the CFPB's rule for electronic transfers from consumer accounts, 12 CFR 1005) covers recurring debits as of October 13, 2026:

• Written and signed. §1005.10(b): recurring debits "may be authorized only by a writing signed or similarly authenticated by the consumer."
• A copy for the customer. Under the same section, whoever gets the authorization must give the customer a copy, on paper or electronically. Hand it over at signing or mail it after.
• Notice when the amount changes. §1005.10(d): if a debit will differ from the last one or from the agreed amount, send written notice of the amount and date at least 10 days before. Reg E has a narrow exception if the customer agreed to be told only when the amount falls outside a set range.
• Stopping payment. §1005.10(c): the customer can stop a recurring debit by telling their bank at least 3 business days before it's due.

If you bill recurring payments through Authorize.Net Automated Recurring Billing, the signed form is your proof that the customer agreed to the whole schedule, not just the first payment. Customers who want to know what they're signing can read our guide on how to pay by eCheck and what you're authorizing.

Use the CCD template when another business pays you from its business checking account, such as a wholesale customer paying invoices or a client on a monthly retainer.

Regulation E protects consumer accounts, so it doesn't cover these payments. Nacha instead requires an agreement between the two businesses, and both must be bound by Nacha's rules. Authorize.Net's guide says CCD needs "an authorization agreement from the corporate customer" and only works with business checking accounts.

A good CCD form covers:

• The customer's legal business name and the name and title of the person signing
• Whether it covers one payment, each invoice as it comes due, or a fixed schedule
• The amount, or how it's set (for example, "the balance of each invoice")
• The business checking account and routing numbers
• A statement that both parties agree to the Nacha Operating Rules
• How and with how much notice either side can end the agreement

A clear, signed agreement up front prevents most arguments about what the customer agreed to pay.

Your authorization records are your proof if a customer tells their bank a payment wasn't allowed. Nacha's rules (Article II, Subsection 2.3.2.7, as quoted in Nacha's 2022 WEB proof-of-authorization guidance) set the minimum:

Be ready to produce it fast. If the customer's bank asks for proof of authorization, Nacha gives the originating bank 10 banking days to provide it. Authorize.Net's guide says it can ask you for a copy at any time and gives you 3 business days to respond. If you don't respond, it allows the return.

Keep it longer if you can. Authorize.Net's guide notes that state laws on payment disputes can run 2 to 7 years. Store records securely: the forms contain full bank account numbers.

A consumer who tells their bank a debit wasn't authorized signs a written statement, and the bank can send the payment back, often as an R10 return, for up to 60 days. See ACH return codes and what to do about returned eChecks for R10 and the other unauthorized codes.

• Using the wrong code for how the customer agreed. A phone payment sent as WEB, or an online sign-up sent as PPD. The code has to match how you got the authorization.
• A one-time form used for recurring charges. If you'll charge again, the form must say how often and until when.
• No way to cancel. Recurring authorizations need clear cancellation steps, and you must stop charging once a customer cancels.
• Changing the amount or date without notice. Reg E requires 10 days' written notice for consumer debits that vary.
• No copy for the customer. For recurring consumer debits, the customer gets a copy. A copy also cuts "I never agreed to this" disputes.
• Taking a TEL payment without a recording or written notice, or calling customers you have no relationship with.
• Losing the records. An authorization you can't find in 10 days is as good as none.
• Vague billing names. If the name on the customer's bank statement doesn't match your business, they may report the debit as unauthorized.

Unauthorized returns are watched closely. Nacha monitors each business's rate of unauthorized returns, and a high rate can put your eCheck service at risk.