customer ACH form Customer ACH Form Customer Information: Customer Name Customer Account Address City State Zip Accounting/ACH Contact Name Phone Fax Email Address for Remittance Advice (**Required**) Above named Customer hereby authorizes the Howard D. Happy Co. of Mayfield Inc. to originate Automated Clearing House electronic funds transfer (EFT/ACH) payment entries, as indicated below, for payment of goods and/or services. Banking Information: Name on Bank Account Bank Routing Number* Bank Account Bank Name p>Bank Address *If you change banks or accounts, please provide at least thirty (30) days written notice. * Customer Authorization: Authorized Name/Title Authorized Signature Date HDH Accounts Receivable Use: Date Received: Date Entered: Entered By: This authority will remain in effect until THE CUSTOMER notifies Howard D. Happy Co. of Mayfield Inc. in writing to cancel it in such time as to afford the Howard D. Happy Co. of Mayfield Inc. and THE FINANCIAL INSTITUTION a reasonable opportunity to act on it. Δ