"Automated Clearing House (Ach) Method Authorization Agreement Form" - California

Automated Clearing House (Ach) Method Authorization Agreement Form is a legal document that was released by the California Public Employees' Retirement System - a government authority operating within California.

Form Details:

  • Released on January 1, 2018;
  • The latest edition currently provided by the California Public Employees' Retirement System;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the California Public Employees' Retirement System.

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Download "Automated Clearing House (Ach) Method Authorization Agreement Form" - California

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Automated Clearing House (ACH) Method Authorization Agreement
Please check all appropriate boxes:
New ACH Method Participant
Change Contact Name and/or Telephone Number
Section I: Business Partner Information
• If you are paying for more than one business partner, a separate ACH agreement form must be submitted for each
business partner.
• Please provide the name and the phone number of ACH contact person that can answer payment questions.
CalPERS ID
Business Partner N ame
Phone Number
Mailing Address (Number, Street, Box Number)
Mailing Address (City, State, Zip Code)
ACH Contact Person
Phone Number
Section II: File Specifications
For assistance, call Twilia Caruthers (916) 795-2948.
(916) 795-129 0
Fax to:
Email to:
FCSD_Cashiers@CalPERS.CA.GOV
Reminder: Before your first payment, contact your bank to ensure maximum fund desired is transferable, and authorized staff can
make payments. This will ensure a smoother transition.
Section III: Verification of Payment
It is the responsibility of each business partner to work with the originating financial institution to obtain verification that your funds
were transferred to CalPERS, and posted correctly.
Departmental Use Only
Receipt Date
Rev. 1/2018 | Page 1 of 1
Automated Clearing House (ACH) Method Authorization Agreement
Please check all appropriate boxes:
New ACH Method Participant
Change Contact Name and/or Telephone Number
Section I: Business Partner Information
• If you are paying for more than one business partner, a separate ACH agreement form must be submitted for each
business partner.
• Please provide the name and the phone number of ACH contact person that can answer payment questions.
CalPERS ID
Business Partner N ame
Phone Number
Mailing Address (Number, Street, Box Number)
Mailing Address (City, State, Zip Code)
ACH Contact Person
Phone Number
Section II: File Specifications
For assistance, call Twilia Caruthers (916) 795-2948.
(916) 795-129 0
Fax to:
Email to:
FCSD_Cashiers@CalPERS.CA.GOV
Reminder: Before your first payment, contact your bank to ensure maximum fund desired is transferable, and authorized staff can
make payments. This will ensure a smoother transition.
Section III: Verification of Payment
It is the responsibility of each business partner to work with the originating financial institution to obtain verification that your funds
were transferred to CalPERS, and posted correctly.
Departmental Use Only
Receipt Date
Rev. 1/2018 | Page 1 of 1