Sample Documents

As a UMACHA member you can take advantage of a number of valuable sample documents, ACH and other electronic payments forms, agreements, and policies.
These documents are available in Word format for you to edit, unless otherwise specified.

Sample ACH Sending Point Agreement
This is a sample agreement between the financial institution and an organization that sends ACH Entries on behalf of the financial institution and their Originators. (2021)

Company/Financial Institution ACH Origination Agreement
This is a sample agreement between the financial institution and the originating company. It is to be used as a starting point and tailored to each financial institution as needed. (2021)

Consumer to Consumer Agreement
This agreement can be used when you have a consumer who wishes to send an ACH Entry to another consumer. (2021)

Corporate Payment ACH Agreement
This is a sample agreement between two companies that agree to exchange corporate ACH payments. (2021)

Third Party Sender Agreement
This is a sample agreement between a financial institution and a Third-Party Sender; a company facilitating on behalf of other companies to originate ACH. (2021)

Third-Party Sender and Originator Agreement
This is a sample agreement between a Third-Party Sender and the originating company.  It is to be used as a starting point and tailored to fit each Third-Party Sender as needed (2021)

ACH Security Framework Guidance And Checklists Final
This checklist was created as a guide to establish a data security framework which meets the minimum obligations per the NACHA Operating Rules. (2021)

Authorization Request Form
This sample form can be used by an RDFI to request proof of authorization from an ODFI. (2021)

Consumer & Corporate ACH Credit Entry Return Form
This form was created to be used with the Return Reason Code R23-Credit Entry Refused by Receiver. (2021)

Corporate ACH Debit Entry Return Form
This form was created to be used when a corporate/business Receiver is stating an Entry is unauthorized. For use with Return Reason Codes R29-Corporate Customer Advises Not Authorized and R31-Permissible Return Entry. (2021)

Direct Deposit via ACH Authorization Originator-Consumer
This authorization is for use between an Originator and a consumer for direct deposit. (2021)

Direct Deposit via ACH Authorization with Split Deposits
This authorization is for use between an Originator and a consumer for direct deposit when the consumer wishes to split the transaction among multiple accounts. (2021)

Direct Payment via ACH Authorization
This authorization is for use between an Originator and a consumer. (2021)

How to Complete a Written Statement of Unauthorized Debit WSUD
The Written Statement of Unauthorized ACH Debit should be used when returning an unauthorized ACH debit Entry.

In-House Credit Authorization Form
This authorization is for use between a financial institution and its customer/member when the financial institution is the Originator. (2021)

In-House Debit Authorization Form
This authorization is for use between a financial institution and its customer/member when the financial institution is the Originator. (2019)

ODFI Request for Return
This form can be used when requesting an R06-Returned Per ODFI's Request from an RDFI. (2021)

Origination Customer List
Use this excel template to keep track of your Originators and their specific relationship details. (2019)

Sample Stop Payment Order Request
The Stop Payment Order Request Form is a sample form that may be used and edited for both consumer and corporate account holders, as well as for paper checks. (2021)

Trading Partner Credit Authorization Form
This is a sample authorization form between two companies that agree to exchange ACH credits. (2021)

Sample Written Statement of Unauthorized Debit WSUD
This version of the WSUD does not include Return Reason Codes. (2021)

Written Statements of Unauthorized Debit (WSUD) with Notary
This version of the WSUD includes Return Reason Codes and a notary. (2021)

Sample Written Statement of Unauthorized Debit WSUD with Return Reason Codes
This version of the WSUD includes Return Reason Codes (2021)

Sample ACH Policy

This is a sample of an ACH Policy. Please use this as a starting point for your financial institution. (2021)

OFAC Policy

This is a sample of an OFAC Policy. Please use this as a starting point for your financial institution. (2021)

UCC 4A PRIMER
This is an explanation of UCC4A and a sample of a disclosure that a financial institution can use. (2021)

Unlawful Internet Gambling Enforcement Act ACH Policy
We have created a sample policy for ACH in regards to Regulation GG; The Unlawful Internet Gambling Enforcement Act. This should be used as a starting point and tailored to your financial institution. There is also one page with sample notices. (2021)