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of the Commonwealth of Pennsylvania

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    Automated Clearing House (ACH) Authorization and ACH Banking Change

    Upon completion of settlement, funding recipients must complete an ACH Authorization form and provide information on any account changes with their financial institution during the repayment process.

    ACH Authorization / Change Form

    Use the instructions below to complete an ACH form for a new loan or report account changes on an existing loan.

    1. 1

      Secure a separate, non-interest-bearing account at a financial institution of your choice.

    2. 2

      Print and complete the confidential ACH Form.

      All information must be complete and must match the information that we have on file with respect to the funding recipient's name, EIN number, and address.

       

      For a new loan:

      Select "Initial Authorization" in the Action Requested section.

       

      For an ACH change request on an existing loan:

      Select "Change" in the Action Requested section.

       

      Enter the PENNVEST loan number(s) that are affected by the change in the "Legacy Loan Number" field.

    3. 3

      Sign and date the form.

      The authorized signature must be an authorized signatory for the funding recipient. If the project has a trustee account, the trustee is responsible for co-signing the form.

    4. 4

      Scan and email the following information:

      • The completed PENNVEST ACH form signed by an authorized signatory of the funding recipient.
      • All pages of the signature card for the bank account, even if pages include blank signature lines, to include any person(s) with the ability to sign on behalf of the funding recipient on the account.
      • A voided check from the bank account; a starter check or counter check is not acceptable and will be rejected.
      • An account verification letter, on the bank's letterhead, from the bank that includes the:
      1. Funding recipient's name.
      2. Funding recipient's address.
      3. Funding recipient's account number.
      4. Funding recipient's routing number.
      5. Last four (4) digits of the funding recipient's EIN number.
      6. Signature and email address on the letter of an authorized signatory of the bank.

    Encryption Questions? Email Heather Brookmyer

    hbrookmyer@pa.gov

     

     

     

     

     

     

    View and Print the ACH Form

     

     

     

     

     

     

     

     

    Submit ACH Information

    ACH forms and all required information should be submitted via encrypted email. Completed forms should be emailed only to the PENNVEST ACH resource account. Use the "Submit ACH Information" button above to submit your information.

     

     

     

     

     

    If you do not have access to encryption, please contact Heather Brookmyer using the "Encryption Questions? Email Heather Brookmyer" button to the left.

     

    ACH forms must be received by the 7th of the month to be in place for the following month's disbursement and/or payment.