Common use of ACH Debit Clause in Contracts

ACH Debit. I hereby authorize the Louisiana Department of Revenue to present debit entries into the bank account and the depository named below. The individual debit transactions will be presented only after being authorized and initiated by the taxpayer. These debits will pertain only to electronic funds transfer payments that the taxpayer has initiated for payment of Louisiana taxes. Signature X Title Date Bank name Branch Bank contact person Telephone Bank account number Type of account Checking Savings Transit and routing number – Name on bank account Before choosing the ACH Credit option, check with your financial institution to ensure that they can comply with the ACH Credit addenda record requirements. See instructions for more information. Effective tax period Initials 9805