ACH Originator Information Sheet
Company Information
Company Name
Street Address
    (include city/state/zip)
Mailing Address
    (include city/state/zip)
Phone Number       Tax ID Number  
Contact Person’s Information:
Name
Email address
Title
Phone       Fax  
ACH Origination Files will be generated:  
If ACH Origination Files will be generated on Inhouse Computer
Hardware Name/Brand/Model  
Software Name/Release/Version
Software Company Name
If ACH Origination Files will be generated by a Servicer
Servicer's Name
Files will get to the bank via:
Tentative dates: Prenote         First Live File  
Does Contract for ACH Origination between bank and customer exist?  
Anyone to be updated on the project's progress or problems encountered besides the contact person. (bank or customer)
Name Phone Email
Name Phone Email
Name Phone Email
Name   Phone   Email
Special Comments or Instructions for Data Processing
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