Authorization for Electronic Funds Transfer

This form authorizes American Society of Heating Refrigerating and Air-Conditioning Engineers, Inc. to transfer funds electronically to you or your Organization's bank account. Questions regarding the information requested on this form should be directed to Jamond Madison at (678) 539-1182.

Mailing Address

Organization Name

Address

Contact Information

This form is being submitted for

If member, please list your member ID here

Name

Phone

Fax

Tax Identification Information

Fed ID#/SS#

Fed ID/SS Name

Beneficiary Institution Information

Bank Name

Name on Account

Address

Type of Account

ABA Routing #

Bank Account #

Swift #

Bank Account #

IBAN/CLABE

Intermediary Institution Information

Bank Name

Name on Account

Address

Type of Account

ABA Routing #

Bank Account #

Swift #

Bank Account #

IBAN/CLABE

Authorization

I authorize ASHRAE, Inc. to deposit, by electronic fund transfer, payments owed to me and, if necessary, debit entries and adjustments for any amounts deposited electronically in error. ASHRAE, Inc. shall deposit the payments in the financial institution and account designated above. I recognize that if I fail to provide complete and accurate information on this authorization form, the processing of the form may be delayed.

Printed Name

Title

Phone