ACH Direct Deposit Form

Money is transferred from one bank account to another by Electronic Funds Transfer (EFT) utilizing the Automated Clearing House (ACH) Network governed by the Federal Reserve System and the National Automated Clearing House Association (NACHA). This is widely used for payroll, social security and investment deposits. The many benefits include:

– Funds reach your bank account days or even weeks sooner
– There is no hold placed on funds
– Eliminates the risk of lost or stolen checks
– Reduces trips to the bank
– WE CHARGE NO FEE FOR THIS SERVICE (You will receive an email notification as well as itemization of the deposit on your monthly statement.)
– Vendor and supplier payments are directly deposited into any personally identifiable bank account.

Form Type(Required)

NEW ACH Direct Deposit

CHANGE ACH Direct Deposit

CANCEL ACH Direct Deposit

Vendor/Payee Information

La Mesa Fund Control - Fund Control # Or Job Site Address(Required)

Vendor / Payee Name(Required)

Vendor Address(Required)

Address 1 Address 2 City State ZIP Code

Phone(Required)

Email(Required)

Your deposit confirmation will be sent via email

Financial Institution Information

Bank Name:(Required)

Branch Address(Required)

Address 1 Address 2 City State ZIP Code

Name on Bank Account:(Required)

Bank Account Number:(Required)

Bank ACH Routing Number:(Required)

Type of Account:(Required)

Business Or

Personal

Type of Account:(Required)

Checking Or

Savings

Approvals/Authorizations - I certify that the information provided on this form is correct, and I hereby authorize La Mesa Fund Control and Escrow to electronically deposit payments to the bank account designated above. It is my responsibility to notify LMFCE (infoap@lmfce.com or (619) 644-8500) immediately if I believe there is a discrepancy between the amount deposited to my bank account and the amount of the invoice(s) paid. I understand that I must notify LMFCE in writing immediately of any changes in status or banking information. I understand that this authorization will remain in full force and effect until LMFCE has received written notification requesting a change or cancellation and has had reasonable opportunity to act on it. Brokerage accounts or money market funds may not be able to recieve deposits via ACH. Deposits returned by your bank, due to incorrect information provided by you, will result in a $30 fee.

Print Name(Required)

Name that will appear on Signature line in the ACH form

Today's Date

Signature(Required)

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