Sample Documents

When you are a member of UMACHA, you can take advantage of a number of resources, including valuable ACH and other electronic payments forms. All agreements, forms and policies are available in Word format for easy editing unless otherwise noted.

 

2017 Updates will be available by end of April 2017.

Agreements

ACH Sending Point Agreement

This is a sample agreement between the financial institution and an organization that sends ACH Entries on behalf of the financial institution and their Originators. (2017)

Company/Financial Institution ACH Origination Agreement

This is a sample agreement between the financial institution and the originating company. It is to be used as a starting point and tailored to each financial institution as needed. (2017)

Consumer to Consumer Agreement

This agreement can be used when you have a consumer who wishes to send an ACH Entry to another consumer. (2017)

Corporate Payment ACH Agreement

This is a sample agreement between two companies that agree to exchange corporate ACH payments. (2017)

Third Party Sender Agreement

This is a sample agreement between a financial institution and a Third-Party Sender; a company facilitating on behalf of other companies to originate ACH. (2017)

 

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Forms

ACH Security Framework Guidance and Checklist

This checklist was created as a guide to establish a data security framework which meets the minimum obligations per the NACHA Operating Rules. (2017)

Authorization Request Form

This sample form can be used by an RDFI to request proof of authorization from an ODFI. (2017)

Authorization Revocation Form

This sample form can be used by a customer to revoke an authorization with an Originator. (2017)

Consumer & Corporate ACH Credit Entry Return Form

This form was created to be used with the Return Reason Code R23-Credit Entry Refused by Receiver. (2017)

Corporate ACH Debit Entry Return Form

This form was created to be used when a corporate/business Receiver is stating an Entry is unauthorized. For use with Return Reason Codes R29-Corporate Customer Advises Not Authorized and R31-Permissible Return Entry. (2017)

Direct Deposit via ACH Authorization Form

This authorization is for use between an Originator and a consumer for direct deposit. (2017)

Direct Deposit via ACH Authorization with Split Deposits Form

This authorization is for use between an Originator and a consumer for direct deposit when the consumer wishes to split the transaction among multiple accounts. (2017)

Direct Payment via ACH Authorization Form

This authorization is for use between an Originator and a consumer. (2017)

In-House Credit Authorization Form

This authorization is for use between a financial institution and its customer/member when the financial institution is the Originator. (2017)

In-House Debit Authorization Form

This authorization is for use between a financial institution and its customer/member when the financial institution is the Originator. (2017)

Letter of Indemnity/Indemnification Letter

This form can be used when requesting an R06-Returned Per ODFI's Request from an RDFI. (2017)

Origination Customer List (Excel)

Use this excel template to keep track of your Originators and their specific relationship details. (2017)

Stop Payment Order Request Form

The Stop Payment Order Request Form is a sample form that may be used and edited for both consumer and corporate account holders, as well as for paper checks. (2017)

Trading Partner Credit Authorization Form

This is a sample authorization form between two companies that agree to exchange ACH credits. (2017)

Written Statement of Unauthorized Debit (WSUD) with Notary

This version of the WSUD has a notary section at the bottom. (2017)

Written Statement of Unauthorized Debit (WSUD) with and without Return Reason Codes

This version of the WSUD includes return codes for use in your operations department. (2017)

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Policy

ACH Policy

This is a sample of an ACH Policy. Please use this as a starting point for your financial institution. (2017)

OFAC Policy

This is a sample of an OFAC Policy. Please use this as a starting point for your financial institution. (2017)

UCC4A Primer

This is an explanation of UCC4A and a sample of a disclosure that a financial institution can use. (2017)

Unlawful Internet Gambling Enforcement Act ACH Policy

We have created a sample policy for ACH in regards to Regulation GG; The Unlawful Internet Gambling Enforcement Act. This should be used as a starting point and tailored to your financial institution. There is also one page with sample notices. (2017)

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Procedures

None at this time.

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