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ACH Customer Form
ACH Customer Form
Wil Coughlin
2023-08-16T10:41:49-04:00
Please complete the following form to provide information related to ACH transfers.
Date Wire Submitted
(Required)
MM slash DD slash YYYY
Confirmation Number
(Required)
Sending Bank
(Required)
Amount of Wire
(Required)
Customer Account Number
Customer Name
(Required)
Customer Contact Name/Sender
(Required)
Email of Sender
(Required)
File
Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.
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