[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-283934-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-283934-en":126},{"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":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","ach-payment-authorization-form-283934","ACH Payment Authorization Form","","ACH Payment Authorization Form authorizes the Delaware River Basin Commission (DRBC) to electronically debit a company’s designated bank account, and to electronically credit it only to correct erroneous debits. The form collects company and account identifiers, including checking or savings selection, depository name, 9-digit routing number, account number, debit authorization amount, and the debit effective date. It also covers invoice or docket references, certification of authorized representation, acknowledgement of rapid withdrawal timing, limited dispute window, and NSF handling. It further states DRBC may retry charges within 30 days and imposes an additional fee per NSF attempt, plus reimbursement for penalties and fees from improperly configured ACH accounts, and binds both parties to NACHA Operating Rules.",{"@graph":14,"@context":73},[15,34,56],{"@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-payment-authorization-form-283934/283934/",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-payment-authorization-form-283934/283934.png","ImageObject",442,249,{"name":42,"@type":43},"Aria Callaghan","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-23","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",16,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What does the ACH payment authorization allow DRBC to do?","Question",{"text":63,"@type":64},"DRBC is authorized to electronically debit the company’s account and, when necessary, to electronically credit the account to correct erroneous debits.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What information is required to set up the debit?",{"text":68,"@type":64},"The form requires the company’s account selection (checking or savings), depository/bank name, 9-digit routing number, account number, the debit amount, and the debit effective date, along with invoice numbers or docket/payment description.",{"name":70,"@type":61,"acceptedAnswer":71},"How are NSF returns handled and what fees may apply?",{"text":72,"@type":64},"If the transaction is returned for NonSufficient Funds (NSF), DRBC may attempt to process the charge again within 30 days, and the company agrees to an additional $35 charge for each NSF attempt returned as a separate transaction. The company also agrees to reimburse penalties and fees if its bank rejects ACH debits or credits due to improper ACH configuration.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},283934,1791034269,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,108,112,117,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":55,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":110,"slug":111},17,40,"forms",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},18,"Letters",30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":109,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":4},962084926284,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","ACH PAYMENT AUTHORIZATION FORM  \nI (we) authorize the Delaware River Basin Commission (“DRBC”) to electronically debit my (our) account and, if necessary, electronically credit my (our) account to correct erroneous debits as follows:  \nCompany Name on Account  \nSelect One:  ✔  Checking Account Savings Account  \nDepository (Bank) Name Routing Number (9-digits)  \nAccount Number  \nAmount of debit authorization $ Debit on or after the following date  \nInvoice Number(s) (preferred), or docket number and/or payment description:  \nI certify that I am an authorized representative of the Company indicated above and that I have the authority to authorize this payment on the Company’s behalf. Company understands that because this is an electronic transaction, these funds may be withdrawn from its account as soon as the above noted transaction date, and that it will have limited time to report and dispute errors. In the case the transaction is returned for NonSufficient Funds (NSF), Company understands that DRBC may, at its discretion, attempt to process the charge again within 30 days and agrees to an additional $35 charge for each attempt returned NSF, which will be initiated as a separate transaction from the authorized payment. Company has certified that the above business bank account is enabled for ACH transactions and agrees to reimburse DRBC for all penalties and fees incurred as a result of Company’s bank rejecting ACH debits or credits as a result of the account not being properly configured for ACH transactions. Both parties agree to be bound by NACHA Operating Rules as they pertain to this transaction. Company acknowledges that the origination of the ACH transactions to its account must comply with the provision [of U.S. law. Company agrees](of U.S. law. Company agrees) not to dispute this transaction with its bank provided the transaction corresponds to the terms indicated in this authorization form.  \nName (Please Print)  \nTitle  \nPhone E-mail  \nSignature Date","cbCaihxn9SSloLSR","https://ap.wps.com/l/cbCaihxn9SSloLSR","pdf",610265,"English","# Authorization Details\n## Account Information\n## Payment Amount and Timing\n## Certification and Agreement Terms","[{\"question\":\"What does the ACH payment authorization allow DRBC to do?\",\"answer\":\"DRBC is authorized to electronically debit the company’s account and, when necessary, to electronically credit the account to correct erroneous debits.\"},{\"question\":\"What information is required to set up the debit?\",\"answer\":\"The form requires the company’s account selection (checking or savings), depository/bank name, 9-digit routing number, account number, the debit amount, and the debit effective date, along with invoice numbers or docket/payment description.\"},{\"question\":\"How are NSF returns handled and what fees may apply?\",\"answer\":\"If the transaction is returned for NonSufficient Funds (NSF), DRBC may attempt to process the charge again within 30 days, and the company agrees to an additional $35 charge for each NSF attempt returned as a separate transaction. The company also agrees to reimburse penalties and fees if its bank rejects ACH debits or credits due to improper ACH configuration.\"}]","ACH Payment Authorization Form | PDF",1789622802]