The ACH/CC Auth Form (commonly referred to as ACH Form) is the billing form used for outright purchase of Turnkey’s products and services.


This form is used for:

  1. One-time Payment for Supply Requests

  2. One-time Payment for Services

  3. Recurring Payment for products and services.


Note: the ACH form is used for payments using Automated Clearing House (ACH) and Credit Card (CC). Payments made via cash/check will be coordinated with US Finance/Admin.


Only ONE payment method is applied. If the merchant decides to fill out both, make sure to let AR know which of the two is being charged.


  

Full Name

Full name of the merchant or signer of the application.

Business Legal Name

Referred to as the “IRS Name”. This is the name they file their taxes under.

Recurring Charge

Check off for recurring payments, such as, but not limited to:


Monthly Marketing Services

Monthly RTF Payments

Consultation Services

Amount

For in-state accounts (within Connecticut), inclusive of 6.35% tax.

For out-of-state accounts, exclusive of tax.

Day

Day of the month the recurring payment will be collected.

Date

Exact date of the first charge.

Goods/Services

Check off that apply.

Description

Short description of the charge.

One-Time Charge

Check off for one-time payments, such as, but not limited to:


Paper Requests

Equipment Purchase

Amount

For in-state accounts (within Connecticut), inclusive of 6.35% tax.

For out-of-state accounts, exclusive of tax.

Date

Exact date of the charge.

Goods/Services

Check off that apply.

Description

Short description of the charge.

Billing Address

By default, this is the Location Street Address.

City, State, Zip

By default, this is the Location City, State, and Zip.

Phone Number

By default, this is the Business Phone Number.

Email

By default, this is the Business Email Address.

Bank Account Type

If the merchant will pay via ACH, check off that apply.


By default, Checking, unless otherwise indicated.

Routing Number

By default, the ABA on file, unless otherwise indicated.

Account Number

By default, the DDA on file, unless otherwise indicated.

Credit Card Type

If the merchant will pay via CC, this is left blank for the merchant to fill out.

Card Number

Left blank for the merchant to fill out.

Expiration Number

Left blank for the merchant to fill out.

CVV

Left blank for the merchant to fill out.

Signature

The document should be signed prior to AR endorsement.

Date

The date the document is signed.