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Pre Authorized Deposit Form Template for United States

A Pre-Authorized Deposit Form is a legal document used in the United States that establishes an agreement between an account holder and a financial institution to allow automatic deposits into a specified account. The form complies with federal regulations including the Electronic Fund Transfer Act and NACHA rules, providing authorization for recurring or one-time electronic deposits while protecting both parties' rights and responsibilities under U.S. banking laws.

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What is a Pre Authorized Deposit Form?

The Pre-Authorized Deposit Form serves as a critical tool in modern banking operations within the United States, enabling secure and efficient electronic fund transfers. This document is essential when setting up direct deposits for payroll, government benefits, investment returns, or other regular payments. The form captures necessary banking information, authorization details, and complies with federal regulations including EFTA and NACHA requirements. It typically includes account holder information, banking details, deposit specifications, and required authorizations to establish automated clearing house (ACH) transfers.

What sections should be included in a Pre Authorized Deposit Form?

1. Account Holder Information: Personal/business details of the account holder including name, address, contact information, and any identification numbers required

2. Financial Institution Details: Banking information including institution name, routing number, account number, and account type

3. Authorization Statement: Explicit consent language for pre-authorized deposits in compliance with EFTA and Regulation E requirements

4. Payment Details: Specific information about the deposits including frequency, amount, start date, and duration

5. Terms and Conditions: Standard terms covering processing timeframes, error resolution, cancellation rights, and notice requirements

What sections are optional to include in a Pre Authorized Deposit Form?

1. Variable Payment Authorization: Additional authorization language for deposits that may vary in amount, including maximum limits and notification requirements

2. Multiple Account Authorization: Authorization details for deposits to be distributed across multiple accounts, including allocation instructions

3. International Transfer Terms: Additional terms for deposits involving international transfers or foreign currencies

What schedules should be included in a Pre Authorized Deposit Form?

1. Schedule A - Void Check: Attachment of a void check or bank document to verify account information

2. Schedule B - Payment Schedule: Detailed schedule of payment dates and amounts if following a specific pattern

3. Schedule C - Privacy Notice: Required privacy disclosures under Gramm-Leach-Bliley Act and state laws

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok成人版 | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents

Jurisdiction

United States

Document Type

Deposit Form

Sector

Banking

Cost

Free to use

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