Versa Press, Inc.ACH Authorization

Please note:

The information submitted in the form below is not saved in our database.
The form is only delivered internally to our accounting department and the sales rep selected in the form.
The Sales Rep does NOT receive your banking info, only notification of the form submission.
All information is submitted over an SSL secured connection.

Please select your Sales Rep to be copied on this email:*
Company Name*
Bank Name*
Account Number*
Bank Routing Number*
Type of Account*
- Checking Account
- Savings Account
Amount Authorized*
Date Authorized To Be Transferred*
MM slash DD slash YYYY
Memo / Invoice No
VERSA PRESS, INC. IS HEREBY AUTHORIZED TO TRANSFER FUNDS FROM THE ABOVE ACCOUNT IN ACCORDANCE WITH THE AFOREMENTIONED INSTRUCTIONS.
Authorized Person's Name*
First Last
Today's Date*
MM slash DD slash YYYY
Email*
Phone*
Authorization*
- I confirm that the above name has given permission and has authorization to approve this transaction.

Versa Press, Inc.