Client Authorization to Debit/Creditform

Clients forms

CLIENT

AUTHORIZATION

TO DEBIT/CREDIT

FORM

Client Authorization to Debit/Credit. This refers to a legal agreement between a client and a financial institution or service provider, allowing the institution or provider to debit or credit the client’s account for certain transactions.

Clients forms

Workers Comp Certificate Request

Employee Onboarding

Employee Time Reporting

Recurring Payment Authorization

Client Authorization to Debit/Credit

Direct Deposit

Client Affidavit Of Zero Wages

Separation Notice

Workers Comp Claim Kit

Client Information

Client Name

DBA Name

Address

FEIN

By signing this Client Authorization to debit/credit, Client authorizes Cornerstone Employer Solutions and its Financial Institutions/ Automated Clearing House (ACH) agents to originate debits to Client’s account at frequent intervals for varying amounts to process automatic, to credit and debit entries and/or correct inadvertent duplicates and/or erroneous credit/debit information associated with the account specified below and any other Cornerstone Employer Solutions service agreements. It is acknowledged and accepted that Cornerstone Employer Solutions may debit Client’s account within five (5) days or less of Client incurring an obligation to Cornerstone Employer Solutions. The term of this agreement shall coincide with, and be in congruence with, the term of other Cornerstone Employer Solutions service agreements. This agreement applies to any Client bank specified by the Client at any time while utilizing Cornerstone Employer Solutions services.

Client’s Current Bank Account to be used to fund fees and related transactions pursuant to the Professional Employer Service Agreement:

Bank Name

Bank Branch (If Applicable)

Bank Address

City

State

Zip

Bank Account Name

Bank Contact

Bank Account Number

Bank Phone Number

ABA Route Number

Type

Add file (1 MB)

*Any official bank form displaying the company name, routing and account number are also accepted (PDF, JPEG, JPG, PNG)

This signed agreement may be considered as an application for credit, and therefore authorizes Cornerstone Employer Solutions and its agents to investigate the credit of the Client named in this document and its principals. Credit Checks involve checking with vendors, references, and Client bank to verify status, history and other applicable credit information. Client acknowledges that it must be accepted for ACH services upon verification and approval of Client’s credit information. Cornerstone Employer Solutions reserves the right to refuse ACH services to any Client or client.

Client acknowledges that they shall utilize the services of Cornerstone Employer Solutions and its agents for the purposes of transferring funds through ACH in accordance to the rules of the National Automated Clearing House Association (NACHA), the laws of Florida and any applicable state, and all the applicable federal rules and regulations for various purposes that include, but are not limited to: direct deposit distribution of the Client’s employee payroll funds, flexible benefit plans, taxes, child support, or any other applicable reason that the Client may desire to transfer funds electronically through ACH.

IMPORTANT: Client is responsible to have all necessary funds on hand and fully fund all ACH transmissions processed by Cornerstone Employer Solutions on Client’s behalf. Client is responsible for any and all losses, liabilities and related recovery expenses that may occur due to incorrect data, rejected transfers, insufficient funds, unlawful activity and any unauthorized ACH transmissions. Client acknowledges that if sufficient funds are not available by the date required pursuant to this agreement, (1) Client will immediately become solely responsible for all tax deposits and filings, all employee wages, all wage garnishments, and all related penalties and interest due then and thereafter, (2) any and all Cornerstone Employer Solutions services may, at Cornerstone Employer Solutions’s option, be immediately terminated, (3) neither Bank nor Cornerstone Employer Solutions will have any further obligation to Client or any third party with respect to any such services, and (4) Cornerstone Employer Solutions may take such action as it deems appropriate to collect Cornerstone Employer Solutions’s services fees pursuant to the Professional Employer ServiceAgreement between the parties.

I, an authorized representative of Client and on behalf of Client, authorize Cornerstone Employer Solutions and its agents to initiate ACH credits and debits from all accounts indicated by my company for payroll and related processing services. Client is responsible to provide to Cornerstone Employer Solutions all data necessary for processing of all ACH transactions. Client is responsible for ensuring that all employees understand their responsibilities as they relate to ACH as per Cornerstone Employer Solutions Employee Authorization Form provided.

Name