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ACH Origination Application for Business Members(To be completed by VACU business member requesting ACH origination capability)Section I – Company InformationCompany Name:Tax ID:Mailing Address:Physical Address:(If different than above)Company Telephone Number:FAX:Primary ACH Contact Name and Title:Telephone Number:FAX:If applicable:Secondary ACH Contact Name and Title:Telephone Number:FAX:If applicable:IT Security Administrator Contact Name and Title:Telephone Number:FAX:Type of Business:Check One: LLC Corporation Partnership Sole Proprietorship OtherDate of Incorporation or Organization://State of Incorporation or Organization: VirginiaDo you have an existing deposit or loan account relationship with VACU? Yes NoIf Yes, please check any of the following documents which are already on file with VACU: Organization Documents (for LLCs) Corporate Resolution or Partnership Agreement Copy of Financial Statements (Signed and Dated) Prior Year Tax Return Copy (Signed and Dated) Credit ReferencesPage 1 of 6Application for ACH Origination Business MembersREV. 02/20/2019
Section II – ACH Origination InformationTo ensure compatibility with our Internet-based software program for ACH origination and/or submission, pleaseverify you have: High-speed Internet W indows 7 or later Microsoft Internet Explorer 11Security and Restrictions: YesAntivirus Software Installed:Restrict Access Days to: MonRestrict Access Time to:FromRestrict Access by IP Range:FromName: Tues W ed. Thursa.m.To.To Fri Sat Sunp.m.Will you be creating NACHA-formatted ACH files using your own software program? Yes* No* If “Yes”, please specify the softwareUse of this software is subject to VACU approvalChecking Account Number to be used for Settlement purposes and ACH Fees:Page 2 of 6Application for ACH Origination Business MembersREV. 02/20/2019
Please describe the purpose of ACH transactions to be originated:ACH Credits PurposePayrollFrequency Daily W eekly Bi-weekly MonthlyTransactions to becredited/debited on:Transaction Type PPD (Credits or Debitsto Consumer Accounts) CCD (Credits or Debitsto Corporate Accounts) Other:Anticipatedmaximumamount of:Any single ACHfile submitted atone time: Total ACH files tobe submitted inany one day: Any single ACHTransaction: Disbursements Daily W eekly Bi-weekly MonthlyTransactions to becredited/debited on: PPD (Credits or Debitsto Consumer Accounts) CCD (Credits or Debitsto Corporate Accounts) Other:Any single ACHfile submitted atone time: Total ACH files tobe submitted inany one day: Any single ACHTransaction: Tax Payments Daily W eekly Bi-weekly MonthlyTransactions to becredited/debited on: PPD (Credits or Debitsto Consumer Accounts) CCD (Credits or Debitsto Corporate Accounts) Other:Any single ACHfile submitted atone time: Total ACH files tobe submitted inany one day: Any single ACHTransaction: Other Daily W eekly Bi-weekly MonthlyTransactions to becredited/debited on: PPD (Credits or Debitsto Consumer Accounts) CCD (Credits or Debitsto Corporate Accounts) Other:Any single ACHfile submitted atone time: Total ACH files tobe submitted inany one day: Any single ACHTransaction: Page 3 of 6Application for ACH Origination Business MembersREV. 02/20/2019
ACH Debits PurposePayment CollectionsFrequency Daily W eekly Bi-weekly MonthlyTransactions to becredited/debited on:Transaction Type PPD (Credits or Debits toConsumer Accounts) CCD (Credits or Debits toCorporate Accounts) Other:Anticipatedmaximumamount of:Any single ACHfile submitted atone time: Total ACH filesto be submittedin any one day: Any single ACHTransaction: Contributions Daily W eekly Bi-weekly MonthlyTransactions to becredited/debited on: PPD (Credits or Debits toConsumer Accounts) CCD (Credits or Debits toCorporate Accounts) Other:Any single ACHfile submitted atone time: Total ACH filesto be submittedin any one day: Any single ACHTransaction: Fees Daily W eekly Bi-weekly MonthlyTransactions to becredited/debited on: PPD (Credits or Debits toConsumer Accounts) CCD (Credits or Debits toCorporate Accounts) Other:Any single ACHfile submitted atone time: Total ACH Filesto be submittedin any one day: Any single ACHTransaction: Membership Dues Daily W eekly Bi-weekly MonthlyTransactions to becredited/debited on: PPD (Credits or Debits toConsumer Accounts) CCD (Credits or Debits toCorporate Accounts) Other:Any single ACHfile submitted atone time: Total ACH Filesto be submittedin any one day: Any single ACHTransaction: Page 4 of 6Application for ACH Origination Business MembersREV. 02/20/2019
Other Daily W eekly Bi-weekly MonthlyTransactions to becredited/debited on: PPD (Credits or Debits toConsumer Accounts) CCD (Credits or Debits toCorporate Accounts)Any single ACHfile submitted atone time: Total ACH Filesto be submittedin any one day: Other:Any single ACHTransaction: Answer the following questions about your ACH activity: (Needed to establish user settings within the ACH Service.)Will you be submitting transactions for same-day ACH processing? Yes NoIf Yes, specify which transactions:Does your company currently originate ACH transactions? Yes NoIf Yes, average monthly activity:ACH Files: Total # sentDollar volume of ACH files: ACH Trans: Total # sentACH Returns: # received back:Dollar volume of ACH Returns: Do you send Prenotes for new transactions: Yes NoIf No, estimated monthly activity:ACH Files: Est. # sentEst. total dollar volume: ACH Trans: Est. # sentPage 5 of 6Application for ACH Origination Business MembersREV. 02/20/2019
By signing below, you grant permission for VACU to obtain credit information from reporting agencies.Application Date://Signature of Company Official:Printed Name and Title:FI Use Only:CIF #:Application: Approved Denied on / / byRelationship Manager Approved Denied on / / byEVP or CCO; MBSPage 6 of 6Application for ACH Origination Business MembersREV. 02/20/2019
Checking Account Number to be used for . Settlement. purposes and . ACH Fees: Page 3 of 6 Application for ACH Origination Business Members REV. 02/20/2019 . Please describe the purpose of ACH transactions to be ori
