ACH Implementation / Change Form
Entities receiving PENNVEST funds must submit an ACH Authorization and/or Change Form to authorize the implementation or any changes to its Financial Institution or Account Number for continued payment processing and/or repayments.
If you are authorizing the ACH implementation, you must open a separate non-interest bearing account for the PENNVEST funds.
ACH implementations must be received before the 5th day of the month to be effective on the first business day of the following month.
ACH changes must be received before the 20th of the month to be effective on the first business day of the following month.
1. Print the ACH Authorization and/or Change Request form.
2. Complete the information for ALL boxes on the form. All blocks are to be completed in order to properly process your request.
3. Sign and date the form. The authorized signature must be the authorized signature for the referenced bank account, not the referenced loan. If the project has a Trustee Account and the Trustee is responsible for the bank account, the Trustee must co-sign the form.
4. Email the scanned form along with a copy of a voided check from your designated account to RA-PVACHFORMS@pa.gov
IMPORTANT - YOU WILL NEED TO SUBMIT A COPY OF A VOIDED CHECK ALONG WITH YOUR ACH IMPLEMENTATION/CHANGE REQUEST FORM