AFT ELECTRONIC PAYMENT (ACH) AUTHORIZATION FORM

I hereby authorize the American Federation of Teachers, AFL-CIO (AFT) to initiate deposit/ credit entries and, if necessary, debit entries for adjustments to correct any inadvertent errors against the bank account provided below. The ACH transaction is generally for the purpose of payment for services rendered to AFT, reimbursement of expenses associated with AFT meetings or events, or other financial assistance being provided to my organization.

Name of the payee (i.e. the organization name or individual) Note: if AFT affiliate, please include affiliate name and number.

General description of payments to be deposited into this account.

BANK INFORMATION

Name of your bank

ACCOUNT INFORMATION

Name of the organization or individual (as identified on the bank account)

ACH routing number

Account number

AUTHORIZING INDIVIDUAL

Name of individual authorized to provide this information

Authorizing individual email address

Repeat email address

Your signature

Sign above

Accounts receivable email address (will be notified when ACHs are forthcoming). Enter an email here only if different from above.

This authority is in full force and effect until AFT has received written notification from me of its termination, in such time and in such manner as to afford AFT a reasonable opportunity to act on it.