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Clearinghouse ACH Authorization Form
Teleflora Shop Code
*
Shop Name
*
Security Pin on TF Acct .
*
FYI: Please be advised that if multiple bank accounts are not entered, all deposits will go to the one provided.
Please enter (Agreed) and (initals) that you have read and understand.
*
ACH Options
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ACH Standard Direct Deposit
ACH Immediate Direct Deposit
ACH Immediate: Funds will be released on the 10th (except for weekends or holidays) Funds available 1-2 business days after the 10th. This option has a fee associated of 2% of the check amount plus 5.00.
ACH Standard: Funds will be released on the 25th (except for weekends or holidays) Funds will be available 1-2 business days after the 25th. This option is free and has no other fees associated.
Name on Bank Account
*
Bank Name
*
Bank Routing Number
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Bank Account Number
*
Credit Card Deposit only
*
Does Not Apply
Credit Card Deposits
If you wish to set up a separate account for Credit Card Deposits, please enter the banking information below.
Name on Bank Account
Bank Name
Bank Routing Number
Bank Account Number
Please upload copy of pre-printed business check
Note: Set up for Canadian Acct may be delayed if a copy of a pre-printed check is not provided.
(If you are unable to upload here please contact Customer Service.)
Name of Person Requesting the change ( must be owner of the account that is on file with Teleflora )
*
First
Last
I have Read , Understand and a Agree to the Terms below
*
I Agree
Terms for ACH Deposit option will be defined below :
1. This option is not immediately active. It could take at least one billing cycle to begin.
2.Owner must agree to this change.
3.In the event that the bank account information changes, the shop owner is responsible for calling Teleflora to make the appropriate changes before the 5th of the month in order to insure the correct account receives the deposit.
4. This option DOES NOT give Teleflora the permission to DEBIT from your bank Account. If you would like to set up this option for payment, it will require a different form to be submitted.Please contact Teleflora Customer Service at 1-800-421-2815 Option #4 to request this form.
Signature
*
Clear
*Please sign to advise that you have requested this change and understand that it could take up to one billing cycle for the change to take effect. *
Contact Phone Number
*
In the event that there are issues processing your request,please provide a contact phone number where you can be reached.
Contact Email
*
Please provide a contact email if you prefer this form of communication.
Referred By :
First
Last
If you were referred to the form by a CS Agent please add their name here.