ACH (Automated Clearing House) Update

Agency Information Change/Update
Agency Principal
Agency Name*
Taxpayer ID #*
Producer Code
Location ID
Agency Principal Name*

First NameLast Name
Agency Principal Email*
Agency Principal Phone*
Agency Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
ACH Credit Authorization

Please provide the accounting contact information for your agency
Payee Name*
Accounting Contacts
Name*
Title*
Phone Number*
Primary Contact Email*
Payee Signature
The payee described above hereby authorizes Swyfft, LLC to initiate automated clearing house (ACH) credit entries the financial institution set forth below in payment of Commissions issued by Swyfft to Payee. This authorization will remain in full force and effect until Swyfft receives written notification of termination and has a reasonable period of time (not less than 10 business days) to act upon such notice.
Signature

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Bank Information
Name*
Title*
Bank Name*
Bank Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Transit/Routing Number*
Bank Account Number*
Depository Account Title
Account Type*

CheckingSavings
Please upload a voided check or bank statement (with Transit/Routing and Bank Account numbers)*

Cancelof
For the Agency Owner / Principal

By signing the below, I attest all information presented in this form is accurate and correct to the best of my knowledge.
Name*

First NameLast Name
Title*
Signature*

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Date*

MonthDayYear
Should be Empty:

Agency Information Change/Update

Agency Principal

ACH Credit Authorization

Accounting Contacts

Payee Signature

Bank Information

For the Agency Owner / Principal