Authorization Agreement for Receipt of Distribution by ACH

We hereby authorize The Philadelphia Foundation, Inc, hereinafter called COMPANY, to initiate and send credit and/or debit entries to our account at the depository financial institution named below, hereafter called DEPOSITORY.

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OrgName

ContactName

Receiving Organization

Name of Organization	Person Completing Form
Your Phone	Your E-mail

Action (check one)

Initial SetupUpdate Existing AuthorizationCancel Existing Authorization

Bank

Depository (Bank) Name	Account Name/Title
Depository (Bank) City	Depository (Bank) State

Depository Routing Number (9 digits)	Account Number
Account Type

Select the type of verification you are uploading:

Copy of voided checkLetter of verification of account from your bank

Upload File

Email Address to Receive Direct Deposit Notifications

Beneficiary

Originator to Beneficiary (additional reference if needed):

We acknowledge that the originator of ACH transactions to our account must comply with the provisions of U.S. law. We agree to be bound by the NACHA, National Automated Clearing House Association, rules. This authorization will remain in full force and effect until COMPANY has received written notification from us of its termination in such time and in such manners as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

Cancel Reason

We acknowledge that the current ACH authorization will remain in full force and effect until COMPANY has a reasonable opportunity to act on this request and has acknowledged in written form that this change has been processed.

Authorized Signer Name

Date

If you have any questions, please contact our Finance Department at 215.563.6417

Philadelphia Foundation | www.philafound.com | T 215.563.6417

NOTE: By clicking "Next" you will proceed to the e-signature page which must be completed to finalize the process.

Contact Information