Credit-Equity ACH Form

Electronic Funds Transfer (EFT) Authorization Agreement
Reason for Submission*

New EFT EnrollmentChange EFT EnrollmentCancel EFT Enrollment

Customer Equity Account Information
Payee Name (or Legal Business Name)*
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Address*
City*
State*
Zip Code*
Equity Account Numbers*
Account number is listed as "ID" in the upper righthand corner on your monthly statement.

Types of EFT Transactions for Account*

Grain Settlement - By selecting this box, you are granting The Equity authority to deposit funds into the indicated account below for grain settlements.Payment on Account - By checking this box you are granting The Equity authority to withdraw funds from the indicated account for payment on customer balances due based upon payment terms per the Equity's credit agreement. The Equity reserves the right to charge back the customers account a fee of $25 in the instance of a NSF chargeback from the financial institution.
Types of EFT Transactions to Cancel for Account*

Grain SettlementPayment on Account

Review and eSign EFT Authorization Agreement
Customer authorizes Effingham Equity (hereinafter "Equity") to initiate credit and/or debit entries to Customer's account at Customer's financial institution, as indicated above. Customer further authorizes the named financial institution to credit and/or debit Customer's account as set forth in this Agreement. Entries, debits and credits to Customer's account shall be made only as authorized by the terms of this Agreement and in accordance with the Rules of the National Automated Clearing House Association relating to corporate trade payables (hereinafter "Rules"), made a part hereof by reference, as such Rules exist at the time any particular entry is initiated by Equity. All other credit, terms of sale and requirements between Equity and Customer remain in effect. This authorization is subject to continuing approval by Equity.
Date*

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Date
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Signature*

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Review and eSign EFT Authorization Agreement