Automatic Bank Account Withdrawal (ACH)

Enrollment Form

When enrollment becomes effective, your balance due will be deducted from your bank account on or after your due date. Please continue to mail your payment until your monthly Invoice America bill indicates that the automatic withdrawal has been activated. This process normally takes 30 to 60 days, whether enrolling for the first time or making changes to your banking information. You may cancel this service anytime, at least two days prior to your due date by calling, 402-734-4900.

 

You must attach a voided check below (if you don’t use checks, you can ask your bank for a Bank Specification Sheet). Please complete the needed information as shown and make sure you sign where it says “Your signature”. Your bank will not process your enrollment request without your voided check or Bank Specification Sheet, and this form completed with your signature.

You may also enroll by signing the back of the remittance slip on your monthly invoice. Send the signed slip along with your payment to use that account for ACH. 

 

staple

(or tape)

your voided

check here

right click

with your mouse

to print

Attach your voided check

(deposit slip, or savings withdrawal slip)

HERE

* 9 digit bank
routing number

* your bank

account number

savings

checking

Name on bank account (please print)

Name of your bank

* Bank routing number (9 digits)

* Your bank account number

Invoice America Acct #

I hereby authorize Invoice America to deduct the balance due on my account monthly from the listed bank account for payment of my Invoice America charges. In the event funds are not available in my account on the date due, I understand an ACH return fee of $30.00 will be charged to my Invoice America account.

Your signature

Date signed

Please complete the above form. Be sure to sign the form and attach a blank voided check or Bank Specification Sheet and mail to (or you may include them with your monthly payment to Invoice America):

 

Invoice America

Automatic Bill Payment Dept.

12565 West Center Road, Suite 230

Omaha, NE 68144

 

Invoice America., 12565 West Center Road, Suite 230, Omaha, Nebraska 68144