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The form authorizes scheduled charges to the donor’s checking or savings account, identifies billing details, and sets account type, bank name, account number, and routing number. It explains how ACH Debit transactions will appear on the bank statement, how receipts are emailed, and how authorization remains valid until written cancellation. 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You will be charged the amount indicated below . A receipt for each payment will be emailed to you and the charge will appear on your bank statement as an “ACH Debit.”   \nPlease complete the information below:  \nI   authorize the Geneseo Foundation to charge my bank account (full name)  \nindicated below on the   for payment of my  .  \n( MM/DD/YYYY) (gift or pledge)  \nBilling Address   Phone\\#    \nCity, State, Zip   Email    \nAccount Type:  Checking  Savings  \nName on Acct    \n_______________________________  \nBank Name    \nAccount Number    \n_______________________________  \nBank Routing \\#   Bank City/State    \nSIGNATURE   DATE    \nI understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify the Geneseo Foundation in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted periodic payment dates fall on a weekend or holiday, I understand that the payment may be executed on the next business day. I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that The Geneseo Foundation may at its discretion attempt to process the charge again within 30 days, and agree to an additional $40.00 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms indicated in this authorization form.","cbCaifqbgYaROG9W","https://ap.wps.com/l/cbCaifqbgYaROG9W","pdf",177774,"English","# ACH Payment Authorization Form\n## Payment authorization terms\n## Donor and bank information\n## Signature and agreement","[{\"question\":\"What does the ACH Payment Authorization Form authorize?\",\"answer\":\"It authorizes the Geneseo Foundation to charge the donor’s checking or savings account for the one-time gift/pledge amount indicated on the form.\"},{\"question\":\"How will the payment appear on the donor’s bank statement?\",\"answer\":\"The charge will appear as an “ACH Debit,” and a receipt for each payment will be emailed to the donor.\"},{\"question\":\"What happens if an ACH transaction is rejected due to insufficient funds (NSF)?\",\"answer\":\"The Geneseo Foundation may attempt to process the charge again within 30 days and may charge an additional $40.00 for each NSF-returned attempt as a separate transaction.\"}]","ACH Payment Authorization Form - One-Time Gift | PDF",1789622799]