HelloForms
Banking · free template

ACH Authorization Form

Collect written permission for ACH debits, with routing details, amount, frequency and a signed mandate.

A ready-to-use banking & identity form for small teams who need a reliable intake process: 20 questions, 4 pages, 4 conditional rules.

Questions
20
Pages
4
Layouts
classic · card
Conditional rules
4
Typical time
4 min
Preview it in the gallery

Searches this template answers

Also filed under

Live preview and test console

This is the real form. Answer it to test the 2 conditional rules — nothing is sent or stored.

Page 1 of 4 — Account holder

ACH debit authorization

Include your country code.

Every question on this page is currently visible.

What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.

Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.

Who this template is for

ACH Authorization Form is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.

  • Small teams who need a reliable intake process working in banking & identity.
  • Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
  • Anyone replacing chasing missing details over email with one structured record per enquiry.
  • Respondents are the people you send it to — the form asks them 20 questions across 4 screens.
  • Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.

  • 11 questions are required, so submissions arrive complete instead of needing a follow-up email.
  • It collects a verified email address so replies and confirmations land.
  • It captures a phone number for urgent follow-up.
  • It accepts a document or photo upload as evidence.
  • It records a signature you can keep as proof of agreement.
  • It pins the request to a specific date.
  • It captures a full postal address.
  • It captures a numeric value you can filter and sort on.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

  1. 1Press “Use this template” — a fresh copy of ACH Authorization Form lands in your workspace, ready to edit.
  2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
  3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
  4. 4Check the upload limits on the file question so respondents can attach what you actually need.
  5. 5Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
  6. 6Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 4 conditional rules ship with it.

  • Features advanced show logic: if “Is this a one-off or recurring debit?” is Recurring, the form dynamically exposes “Debit frequency”. Otherwise that question never appears.
  • Features conditional validation: if “Is this a one-off or recurring debit?” is Recurring, “First debit date” becomes mandatory before the form can be sent.
  • Features advanced show logic: if “Is this a one-off or recurring debit?” is Recurring, the form dynamically exposes “Number of payments or end date”. Otherwise that question never appears.
  • Features conditional validation: if “Account type” is Business checking, “Registered business name” becomes mandatory before the form can be sent.
  • All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

About this template

An ACH debit without a documented mandate is an unauthorised transaction waiting to be reversed. This form collects the mandate properly. The account holder names themselves exactly as the bank holds them, chooses whether the account is checking or savings and whether it is personal or business, then supplies the routing and account numbers along with the bank name. A recurring mandate branches to ask for the frequency, the first debit date and either an end date or a stated number of payments, so the permission has a boundary the customer actually agreed to. One-off debits ask only for the amount and the date. The authorization wording sets out the customer's right to revoke in writing with reasonable notice and their right to dispute an incorrect amount, which is the language auditors and banks expect to see. A voided check or bank letter can be attached to verify the numbers before the first run, cutting the failed-debit rate that comes from mistyped account digits. The account holder signs and dates on screen, giving you a retrievable, attributable record for every debit you originate.

What this form asks

Every question is editable — rename it, make it optional, or delete it entirely.

Page 1 — Account holder

  • Account holder name as held by the bankrequired
  • Email addressrequired
  • Phone number
  • Billing address
  • Customer or account reference

Page 2 — Bank details

  • Account typerequired
  • Registered business name
  • Bank namerequired
  • Routing number (9 digits)required
  • Account numberrequired
  • Voided check or bank letter

Page 3 — Debit schedule

  • Is this a one-off or recurring debit?required
  • Debit amountrequired
  • Debit frequency
  • First debit date
  • Number of payments or end date
  • What is being paid for?

Page 4 — Authorization

  • ACH authorizationrequired
  • Account holder signaturerequired
  • Date signedrequired

20 questions in total.

How the form changes as it's filled in

This template ships with 4 conditional rules, grouped into 3 behaviours driven by 2 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Is this a one-off or recurring debit?”

  • Reveals questions

    If “Is this a one-off or recurring debit?” is Recurring, the form reveals “Debit frequency” and “Number of payments or end date”.

  • Makes answers required

    If “Is this a one-off or recurring debit?” is Recurring, “First debit date” becomes required before the form can be submitted.

Driven by “Account type”

  • Makes answers required

    If “Account type” is Business checking, “Registered business name” becomes required before the form can be submitted.

Set it up step by step

  1. 1

    Insert your business name

    Replace the placeholder in the authorization text with your legal entity name — the mandate must say who is debiting the account.

  2. 2

    Set the notice period

    Edit the revocation sentence to the notice period your billing team can actually honour, then keep it consistent across every customer.

  3. 3

    Verify before the first run

    Ask for the voided check attachment and check the routing number against it before you originate the first debit.

  4. 4

    Store the signed mandate

    Keep each signed submission for as long as your NACHA or local rules require after the final debit, and produce it on request.

Mistakes to avoid

  • Running a recurring debit from a one-off permission.
  • Omitting the customer's right to revoke, which invalidates the mandate in a dispute.
  • Storing bank numbers in exports that circulate by email.

What it pairs with

Most teams don't run this form on its own. These are the forms and systems it sits next to.

What to do with the responses

Verify the account details, schedule the debit in your processor, and email the customer confirmation of the amount and first debit date.

Works in both layouts

Browse classic templatesBrowse card templates

Forms that overlap this one

These pages cover the same subject ground as the ach authorization form, matched on the words people actually search for.

Privacy & compliance

This form collects identity or financial details. Enable encrypted answers on the sensitive fields, avoid emailing full values in notifications, and delete responses once the check is complete.

Frequently asked questions

How long must I keep an ACH authorization?

Rules commonly require two years after the final debit, and longer under some contracts. Keep the signed submission archived rather than deleting it with the customer record.

Can a customer cancel by phone?

The wording here requires written revocation. Point customers at a short cancellation form so you have the same standard of evidence for stopping as for starting.

Is this the same as a direct debit mandate?

It plays the same role. ACH terminology is US-specific; outside the US rename the fields to your local scheme and keep the branch or sort code equivalent.

Why ask for a voided check?

Because mistyped routing and account numbers cause most failed first debits. The attachment lets you check the digits before you originate anything.

Is the ACH Authorization Form template free to use?

Yes. You can preview and test ACH Authorization Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

What does the ACH Authorization Form template ask for?

It asks 20 questions across 4 pages, 11 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Can I edit the ACH Authorization Form form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this banking & identity form work?

4 conditional rules ship with the template: Features advanced show logic: if “Is this a one-off or recurring debit?” is Recurring, the form dynamically exposes “Debit frequency”. Otherwise that question never appears. Features conditional validation: if “Is this a one-off or recurring debit?” is Recurring, “First debit date” becomes mandatory before the form can be sent. Features advanced show logic: if “Is this a one-off or recurring debit?” is Recurring, the form dynamically exposes “Number of payments or end date”. Otherwise that question never appears. All rules are editable in the Logic tab.

Where do responses to the ACH Authorization Form form go?

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Can I embed the ACH Authorization Form form on my own website?

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.

Can respondents upload files?

Yes. This template includes a file upload question, so respondents can attach documents or photos with their answers. You can adjust the accepted file types and size limits on that question.

Is the signature on this form legally usable?

The template captures a drawn signature and stores it with the submission, along with the timestamp, so you keep evidence of who agreed and when. Whether that is sufficient depends on your jurisdiction and the agreement itself.

Related templates

More forms teams pair with the ach authorization form.

Related categories

All Banking & Identity templates