This form is an authorization agreement for Automated Clearing House pre-authorized corporate payments.

The undersigned hereby authorizes the U.S. Postal Service to originate debit and/or credit entries via the Automated Clearing House to the account indicated below at the Depository Financial Institution named below, to accept and to debit/credit the amount of such entries to the account.

Bank Name:  
Contact Name: Telephone No.: 
Address:   
City:  State:  ZIP+4: 
Bank Account Number:  Bank Transit ABA Number: 

This authorization will remain in effect until written notification of termination has been given by the customer and that notification has been received by the Manager, CAPS Service Center (for the U.S. Postal Service). In addition, the U.S. Postal Service, in its discretion, may terminate the customer's ability to participate in the Electronic Funds Transfer system. Any termination will take effect only after all entries originated by the U.S. Postal Service have been honored by the bank.

Name: (As shown on bank account)  
Taxpayer ID Number: 
CAPS Account Number: (if available) 
Address:  
City:  State:  ZIP:  

Original Authorized Signature
Signature:  Date: 
Please print name and title: 

Customer, by its signature above, and the U.S. Postal Service, by its initiation of a debit authorized, hereby agree to be bound by the National Automated Clearing House Association (NACHA) rules relating to Corporate Trade payment entries in the administration of these debit entries. Debit entries will be initiated only as authorized above. Any issues, objections, or discrepancies regarding the amounts debited will be reported in writing to:

no later than 90 days from the debit date. Failure to deliver such notice within the prescribed period will serve as an absolute waiver by the Customer of any and all remedies, causes of action, and other forms of relief arising out of or in connection with each such debit transaction. The U.S. Postal Service will then have 30 days in which to respond.

This authorization is not governed by the provisions of Postal Service Publication Number 41, Procurement Manual, or the Contract Disputes Act.