ACH Form

This document must be filled out by pool members requesting automatic deposit of expense reimbursements from the Club.

Name*
First Last
Address*
Street Address City State ZIP Code
Email*
Account Institution*
Account Type*
- Checking
- Savings
Bank Routing Number (ABA Number)*
Account Number*
Voided Check*
Max. file size: 5 MB.

Upload a scanned copy or photo of a voided check. If you do not have a check, you can upload a screenshot of your bank info that includes your account and routing numbers. Email [email protected] with any questions.
Claimant Signature*
This form authorizes Little Falls Swimming Club (the "Company") to send credit entries (and appropriate debit and adjustment entries) electronically or by any other commercially accepted method, to my (our) account(s) indicated above and to other accounts I (we) identify in the future (the "Account"). This authorizes the financial institution holding the Account to post all such entries. I agree that the ACH transactions authorized herein shall comply with all applicable U.S. Law. This authorization will be in effect until the Company receives a written termination notice from myself and has a reasonable opportunity to act on it.
Order Token