[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-288378-105":3,"doc-detail-288378-en":80,"detail-sidebar-cat-1-en-105":95},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","ach-authorization-form","ACH Authorization Form","","This document is an ACH Direct Withdrawal Authorization form for the Northeast Regional Water District (NRWD). It serves as an official agreement allowing the utility provider to automatically debit a customer's checking or savings account for monthly billing payments. The form collects essential customer and financial institution information, including account and routing numbers. By completing this authorization, the account holder agrees to payment schedules, discrepancy reporting protocols, and policies regarding rejected transactions or insufficient funds.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/ach-authorization-form/288378/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/ach-authorization-form/288378.png","ImageObject",442,249,{"name":42,"@type":43},"wps_ap_test_251126_0180","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-23","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":30},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"On what day of the month are payments typically withdrawn?","Question",{"text":62,"@type":63},"Payments are withdrawn on the 10th of every month, or the following business day if the 10th falls on a weekend or holiday.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"What is the penalty for a rejected ACH transaction?",{"text":67,"@type":63},"Rejected transactions are subject to a fee set by the district, which is currently $25 per transaction and is subject to change.",{"name":69,"@type":60,"acceptedAnswer":70},"What documentation must accompany this form for bank verification?",{"text":71,"@type":63},"A voided check from the account holder must be submitted along with the completed authorization form.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},288378,1789633423,{"code":4,"msg":81,"data":82},"success",{"doc_id":78,"user_id":83,"nickname":42,"user_avatar":84,"doc_module":22,"category_id":85,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":86,"file_id":87,"file_url":88,"file_type":89,"file_size":90,"view_count":33,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":91,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":92,"faqs":93,"seo_title":94,"seo_description":12,"update_tm":79,"read_time":4},8796095027276,"https://avatar.qwps.com/avatar/d3BzX2FwX3Rlc3RfMjUxMTI2XzAxODA=",17,"ACH DIRECT WITHDRAWAL AUTHORIZATION  \n Enroll  Change  Cancel  \nCUSTOMER INFORMATION  \n10 DIGIT ACCOUNT NUMBER:   -   -   \nNAME:    \nADDRESS:    \nCITY:   STATE:   ZIP    \nPHONE:   EMAIL:    \nBANK INFORMATION (VOIDED CHECK MUST ACCOMPANY THIS FORM)  \nBANK NAME:    \nBANK PHONE NUMBER:  \n___________________________ _______________________  \nNAME ON ACCOUNT:    \nACCOUNT TYPE (circle one): Checking / Savings  \nBANK ROUTING NUMBER:    \nACCOUNT NUMBER:    \nI authorize Northeast Regional Water District (NRWD) to withdraw the amount shown on my monthly billing statement according to the following schedule from the account listed above. Payment will be withdrawn on the 10th of every month, or the following business day if the 10th falls on a weekend or holiday.  \nI understand that I will receive my monthly statement prior to the last day of each month, and it is my responsibility to report any discrepancies to NRWD at least two days prior to the withdrawal date.  \nI also acknowledge that if my ACH gets rejected for ANY reason, I am subject to the fees set by the district (which is currently $25 per transaction, and subject to change) . NRWD reserves the right to cancel this ACH at any time, due to insufficient funds without notice.  \nSignature:   Date:    \nFor Office Use Only:  \nDate Received:    \nEntered by:   Verified by:","cbCaidtpqT8hVEGm","https://ap.wps.com/l/cbCaidtpqT8hVEGm","pdf",142437,"English","# Customer Information\n# Bank Information\n# Authorization Agreement\n# Office Use Only","[{\"question\":\"On what day of the month are payments typically withdrawn?\",\"answer\":\"Payments are withdrawn on the 10th of every month, or the following business day if the 10th falls on a weekend or holiday.\"},{\"question\":\"What is the penalty for a rejected ACH transaction?\",\"answer\":\"Rejected transactions are subject to a fee set by the district, which is currently $25 per transaction and is subject to change.\"},{\"question\":\"What documentation must accompany this form for bank verification?\",\"answer\":\"A voided check from the account holder must be submitted along with the completed authorization form.\"}]","ACH Authorization Form | PDF",{"code":4,"msg":81,"data":96},[97,102,107,112,117,122,125,130,135],{"id":98,"doc_module":22,"doc_module_name":25,"category_name":99,"show_sort_weight":100,"slug":101},11,"Presentations",90,"presentations",{"id":103,"doc_module":22,"doc_module_name":25,"category_name":104,"show_sort_weight":105,"slug":106},12,"Resumes",80,"resumes",{"id":108,"doc_module":22,"doc_module_name":25,"category_name":109,"show_sort_weight":110,"slug":111},14,"Invoices",70,"invoices",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},15,"Posters",60,"posters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},16,"Social Media",50,"social-media",{"id":85,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":123,"slug":124},40,"forms",{"id":126,"doc_module":22,"doc_module_name":25,"category_name":127,"show_sort_weight":128,"slug":129},18,"Letters",30,"letters",{"id":131,"doc_module":22,"doc_module_name":25,"category_name":132,"show_sort_weight":133,"slug":134},21,"Paper Templates",5,"papers-templates",{"id":136,"doc_module":22,"doc_module_name":25,"category_name":137,"show_sort_weight":4,"slug":138},158,"General","general-158"]