ACH Setup Form

Customer Information

Customer / Company Name *

Phone Number *

Email Address *

Billing Address

Bank Account Information

Account Holder Type*

Account Type *

Bank Name *

Routing Number *

Account Number *

Confirm Account Number *

ACH Account Setup Authorization

By signing below, I authorize Ged’s Floor Store to securely store and use the bank account information provided for ACH payments that I separately authorize for invoices, deposits, balances due, freight charges, service charges, and other amounts owed to Ged’s Floor Store.

This setup form authorizes Ged’s Floor Store to maintain this bank account as an approved ACH payment method. This form does not authorize a specific payment amount unless a separate payment authorization is completed.

I certify that I am an authorized signer on the bank account listed above. I understand that ACH payments are governed by applicable banking rules and NACHA regulations.

If an ACH payment is returned, rejected, disputed, or reversed, I remain responsible for all amounts owed, including any permitted returned payment fees, bank charges, collection costs, attorney’s fees, court costs, and interest permitted by law.

Ged’s Floor Store may re-submit eligible returned ACH transactions as permitted by applicable law and NACHA rules. In the event of non-payment, unpaid balances may be referred to collections or legal proceedings as permitted by Texas law.

Electronic Signature

Full Legal Name *

Date *

I agree that checking this box and submitting this form constitutes my electronic signature and authorization to set up this ACH bank account. I understand that returned or rejected ACH payments may result in additional fees, collection activity, or legal action as permitted by law.