Set up one-time or recurring payments by bank debit with the customer's signed EFT authorization.
Financial template · 12 fields (11 required) · ~3 min for respondents to complete · Free plan · No credit card · Fully customizable
Set up your electronic funds transfer form
Set up one-time or recurring payments by bank debit with the customer's signed EFT authorization.
Name your business and the cancellation notice period in the authorization wording, limit who can see responses, and send the customer a confirmation before the first debit.
The form separates phone number, bank name, account type, routing number into labeled questions. Review the choices and required fields for your organization before sharing it.
Best practices
Name your business and the cancellation notice period in the authorization wording, limit who can see responses, and send the customer a confirmation before the first debit.
Customize the phone number and bank name questions to match your records and terminology.
Name the team that reviews responses and explain what happens after submission. A requested date, service or approval is not automatically confirmed.
Ask only for information needed for this step. Arrange any sensitive supporting documents through an appropriate private process.
Every field, explained
Account holder name (Name, required)
Email address (Email, required)
Phone number (Phone)
Bank name (Short text, required)
Account type (Single choice, required)
Routing number (Short text, required) — The 9-digit ABA routing number shown on a check or in your bank's account details.
Account number (Short text, required)
Payment amount (Number, required)
How often? (Dropdown, required)
First payment date (Date, required)
Authorization (Multiple choice, required)
Account holder signature (Signature, required)
Frequently asked questions
What does this electronic funds transfer form template collect?
Alongside contact details, it asks for phone number, bank name, account type, routing number, account number, payment amount, how often?, first payment date, authorization, account holder signature. You can rename questions, change choices and remove fields that your workflow does not need.
How should I use this electronic funds transfer form form?
Name your business and the cancellation notice period in the authorization wording, limit who can see responses, and send the customer a confirmation before the first debit.
Can I customize the acknowledgment and signature fields?
Yes. Provide your complete reviewed instructions or terms before collecting signatures. The signature field records input; it does not verify identity or guarantee legal effect. You can edit the form and print a copy.