ACH Bank Transfers Physical Checks
 Secure Payment Services by Celect
As a client of Celect, your organization has the ability to use CelectPay, a secure online payment processing service, to collect dues, fees, and/or donations directly from your website. The banking information below is required in order to distribute funds to your organization. You may choose to have to funds automatically distributed to your bank account or have a check mailed to the address of your choice. Either distribution method will be made under the following policies: 1. ACH transfers and/or physical checks will be generated on the second business day of every week, except for holidays. 2. For your records, information regarding funds received from your online payment forms will be emailed to the person of authority you designate below. 3. Any charge-backs and associated fees received by Celect on your organization’s behalf will be deducted from the net amount of funds you receive via check or ACH transfer. Please select a distribution method and provide the appropriate information. Completed forms may be submitted via email at [email protected], or faxed to Celect, Finance Manager, at 217.355.4513.
ACH Bank Transfers
Physical Checks
BANK NAME
PAYABLE TO
ACH ROUTING NUMBER BANK STREET ADDRESS
ORGANIZATION NAME MAILING STREET ADDRESS
CITY, STATE ZIP
CITY, STATE, ZIP
ACCOUNT NAME ACCOUNT NUMBER ACCOUNT TYPE
I certify that I have read and understand the instructions above, and confirm that the information I have provided on behalf of my organization is correct and valid as of _______________________. DATE (MONTH, DAY, YEAR)
________________________________________________________________________________ FULL ORGANIZATION NAME
_________________________________________
_________________________________
NAME (PRINTED)
TITLE (IF ANY)
_________________________________________
_________________________________
SIGNATURE
CONFIRMATION EMAIL
As a client of Celect, your organization has the ability to use CelectPay, a secure online payment processing service, to collect dues, fees, and/or donations directly from your website. The banking information below is required in order to distribute funds to your organization. You may choose to have to funds automatically distributed to your bank account or have a check mailed to the address of your choice. Either distribution method will be made under the following policies: 1. ACH transfers and/or physical checks will be generated on the second business day of every week, except for holidays. 2. For your records, information regarding funds received from your online payment forms will be emailed to the person of authority you designate below. 3. Any charge-backs and associated fees received by Celect on your organization’s behalf will be deducted from the net amount of funds you receive via check or ACH transfer. Please select a distribution method and provide the appropriate information. Completed forms may be submitted via email at [email protected], or faxed to Celect, Finance Manager, at 217.355.4513.
ACH Bank Transfers
Physical Checks
BANK NAME
PAYABLE TO
ACH ROUTING NUMBER BANK STREET ADDRESS
ORGANIZATION NAME MAILING STREET ADDRESS
CITY, STATE ZIP
CITY, STATE, ZIP
ACCOUNT NAME ACCOUNT NUMBER ACCOUNT TYPE
I certify that I have read and understand the instructions above, and confirm that the information I have provided on behalf of my organization is correct and valid as of _______________________. DATE (MONTH, DAY, YEAR)
________________________________________________________________________________ FULL ORGANIZATION NAME
_________________________________________
_________________________________
NAME (PRINTED)
TITLE (IF ANY)
_________________________________________
_________________________________
SIGNATURE
CONFIRMATION EMAIL
