ACH AUTHORIZATION AND DISCLOSURE
ACH AUTHORIZATION AND AGREEMENT
I acknowledge that the “Transfer Funds” feature allows me to electronically transfer funds via the
Automated Clearing House (“ACH”) between my eligible account(s) and my external account(s)
at other financial institutions (“External Account(s)”) once I have successfully registered my
External Account(s). This includes:
● One-time on-demand transfers, which allow me to initiate multiple, non-recurring,
individual transfers based on the transfer date and dollar amount that I request through
the Transfer Funds feature of Online and Mobile Banking from time to time;
● Recurring transfers, which allow me to initiate recurring transfers of a set dollar amount at
regular intervals that I have established through the Transfer Funds feature of Online and
Mobile Banking; and/or
● Other ACH transfer features that Paybotic Financial may make available.
Subject to the terms of the Transfer Funds feature and the terms of my other agreements with
Paybotic Financial, I hereby authorize Paybotic Financial to initiate electronic credit/debit entries
to my eligible Paybotic Financial account(s) and each registered External Account indicated
previously for (a) various amounts at varying times by making on-demand transfers pursuant to
my instructions, and/or (b) fixed amount at the frequency I have selected by making recurring
transfers pursuant to my instructions (a “Preauthorized Transfer”). If any transfer date falls on a
weekend or bank holiday, I understand and agree that the transfer may be executed on the next
business day, or as soon as reasonably possible at the discretion of Paybotic Financial.
I hereby represent and warrant that I have all necessary right, power and authority to debit and
credit my Paybotic Financial account and any External Account(s) registered, and that all
information or instructions that I provide to Paybotic Financial in relation to any ACH transfer is
complete and accurate. I agree that ACH transactions I authorize comply with all applicable law.
Should an incorrect amount be withdrawn from or deposited to my External Account(s) or my
Paybotic Financial account(s), I authorize Paybotic Financial to correct the error by
debiting/crediting my External Account(s) or my Paybotic Financial account(s).
This authorization is to remain in full force and effect until Paybotic Financial has received written
notification from me of its termination in such a time and in such a manner as to afford Paybotic
Financial a reasonable opportunity to act on it. For Preauthorized Transfers, I understand that it
is my responsibility to contact Paybotic Financial to stop or cancel a Preauthorized Transfer at
least three business days prior to the following scheduled payment. In either case, I will send
my notice to:
Paybotic Financial: 1800 S Australian Ave, #400, West Palm Beach, FL 33409
I acknowledge that the origination of ACH transactions must comply with the provisions of
applicable law and the rules of the National Automated Clearing House Association (NACHA). I
request the financial institution that holds my External Account(s) to honor all transfers initiated in
accordance with this authorization form.External Account Routing Number:
External Account Number:
I agree to print this ACH Authorization and retain a hard copy or save as an electronic copy.
[Customer signature collected electronically]
Customer:
Consent ID:
Date: