[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-283722-105":53,"doc-detail-283722-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","automated-clearing-house-ach-authorization-form","Automated Clearing House (ACH) Authorization Form","","Nationwide Retirement Solutions provides an Automated Clearing House (ACH) Authorization Form to collect participant details and banking information for electronic credit and/or debit transactions. The form captures personal data, preferred contact information, account type, routing and account numbers, and the specific update request type such as Direct Deposit and Loan Repayment. It outlines authorization scope, revocation timing, and processing terms, including NSF rejection handling, potential retry windows, and possible NSF-related fees. It also states reimbursement obligations if ACH is not properly configured, along with signature and return instructions.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/automated-clearing-house-ach-authorization-form/283722/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/automated-clearing-house-ach-authorization-form/283722.png","ImageObject",442,249,{"name":88,"@type":89},"Aurora","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-11-02","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":20},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What transactions does the ACH Authorization allow Nationwide to initiate?","Question",{"text":108,"@type":109},"It authorizes one-time or recurring ACH credits and/or debits to the participant’s referenced bank account, including deposits or withdrawals for amounts due between the participant and Nationwide.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How can a participant revoke the authorization?",{"text":113,"@type":109},"The form states the authorization remains in effect until written notice of revocation is delivered to Nationwide at least 15 days before the next authorized transaction due date.",{"name":115,"@type":106,"acceptedAnswer":116},"What happens if an ACH debit is rejected due to insufficient funds (NSF)?",{"text":117,"@type":109},"If an ACH debit is rejected for NSF, Nationwide may attempt to process the debit again within 30 days and may process a one-time NSF fee debit if permitted by law, with each action treated as a separate ACH transaction.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},283722,1790179389,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":20,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":4},4810365810221,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Nationwide Retirement Solutions  \nAutomated Clearing House (ACH) Authorization Form Page 1 of 1  \nPersonal Information  \nName:   Account Number or SSN:    \nEmail:   Preferred Phone:    \nPhone Type: c Home c Work c Cell  \nACH Update Request Type (select all that apply)  \nACH information will be updated based on your selection(s) . If left blank, all applicable ACH information will be updated. c Direct Deposit (updating your bank account information to receive a distribution or payout)  \nc Loan Repayment (updating your bank account information associated with a loan)  \nLoan number(s) if applicable:    \nFinancial Institution Information (select one)  \nIf account type is not selected or both are selected, checking will be used.  \nType of Account (check one): c Checking c Savings  \n\n| Financial Institution Name |\n| --- |\n| Routing Number |\n\nAccount Number  \nNOTE: Please see check image to assist in locating your bank account information. If this bank account is a joint account, authorization by one account owner constitutes authorization by all account owners - whether a current owner of this account or added after the date of this Authorization.  \nJohn Doe  \n123 Main Street Ph. (916) 555-1212  \nHometown, CA 98765 Date  \nPAY TO THE ORDER OF  \n$  \nMoney Bank, Inc.  \n321 Main Street  \nHometown, CA 98765  \nMEMO  \n| :123456789 | : 000012345678 || • 1492  \n1492  \nDOLLARS  \n9-digit Routing Number Checking Account Number Check Number  \nParticipant or Claimant Authorization  \nWhat you need to know  \nBy signing this form (this “Authorization”), you authorize Nationwide Mutual Insurance Company, Nationwide Trust Company, FSB, Nationwide Life Insurance Company, or any of its affiliates (collectively,“Nationwide”) to initiate one-time or recurring credit(s) or debit(s) to your bank account referenced above. This Authorization also allows Nationwide to make one or more deposits or withdrawals (via ACH debit and/or credit) to your bank account for any contribution, refund, credit, payment or other amount that may now or at any time be due or owed between you and Nationwide. This Authorization will remain in effect until you deliver written notice of revocation to Nationwide at least 15 days prior to the next authorized transaction’s due date.  \nAcknowledgment and Agreement  \nIf any ACH debit is rejected for Non-Sufficient Funds (NSF), you agree that Nationwide may, at its discretion, attempt to process the debit again within 30 days, and further agree that Nationwide may process a one-time ACH debit for a NSF fee, in an amount permitted by law for each debit returned, each of which will be initiated as a separate ACH transaction to the your bank account. Both parties agree this Authorization constitutes authorization to debit and credit your bank account identified above, and you agree not to dispute any transactions with your bank provided said transaction conformsto the terms of this Authorization. You certify that the bank account above is enabled for ACH transactions and agree to reimburse Nationwide for all penalties and fees incurred should your bank reject ACH debits or credits as a result of the account not being properly configured for ACH transactions.  \nSignature:   Date:   NOTE: e-signature & digital signature not accepted unless submitted via DocuSign  \nForm Return  \nBy mail: Nationwide Retirement Solutions By fax: 1-877-677-4329  \nPO Box 182797  \nColumbus, OH 43218-2797 By email: [rpublic@nationwide.com](rpublic@nationwide.com)  \nDC-2395 (09/2024) For help, please call 1-877-677-3678 [nrsforu.com](nrsforu.com)","cbCaiotqFcXYhLFz","https://ap.wps.com/l/cbCaiotqFcXYhLFz","pdf",61091,"English","# Personal Information\n# ACH Update Request Type\n# Financial Institution Information\n# Participant or Claimant Authorization\n# Signature and Form Return","[{\"question\":\"What transactions does the ACH Authorization allow Nationwide to initiate?\",\"answer\":\"It authorizes one-time or recurring ACH credits and/or debits to the participant’s referenced bank account, including deposits or withdrawals for amounts due between the participant and Nationwide.\"},{\"question\":\"How can a participant revoke the authorization?\",\"answer\":\"The form states the authorization remains in effect until written notice of revocation is delivered to Nationwide at least 15 days before the next authorized transaction due date.\"},{\"question\":\"What happens if an ACH debit is rejected due to insufficient funds (NSF)?\",\"answer\":\"If an ACH debit is rejected for NSF, Nationwide may attempt to process the debit again within 30 days and may process a one-time NSF fee debit if permitted by law, with each action treated as a separate ACH transaction.\"}]","Automated Clearing House (ACH) Authorization Form | PDF",1789617759]