Transfer Information Form Transfer Information Form Electronic Funds Transfer Information This Electronic Funds Transfer Information Form is for the establishment and/or update of banking information, billing dates, checking and credit card processing and changes of address. Step 1 of 4 25% * ALL SENSITIVE INFORMATION IS ENCRYPTED FOR YOUR SECURITY AND NOT SHARED WITH ANY OTHER ENTITY.FORM DESCRIPTIONForm Reason:*Select the reason for the submission of this form.First Time SetupChange of Address - Phone, Email, WebsiteChange In EFT Contact / Authorized SignerChange of Bank InformationChange of Checking Billing DatesChange of Credit Card Billing DatesChange of Checking & Credit Card Billing DatesBUSINESS INFORMATIONBusiness Name (DBA):*Enter the name of the business.Business Phone:*Enter the business telephone number.Business Website:Enter the website address of your business. Contact Name:*Enter the business contact name. First Last Contact Email:*Enter your email address. EIN - Tax ID*Enter the Employer - Tax Id.Business Address:*Enter your business address. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Organization Type:*Select the business organization type.Sole ProprietorC - CorporationS - CorporationLLC - CorporationPublic CorporationTax Exempt CorporationClosely Held CorporationNot For ProfitGeneral PartnershipLimited PartnershipGovernmentEstateTrustCORPORATE INFORMATIONCorporation Name:Enter the name of your corporation.Corporate Contact:*Enter the corporate contact. First Last Corp. Contact Title:*Enter the contact title.OwnerPresidentVice PresidentDirectorSecretaryTreasurerAdministratorManagerLimited PartnerManaging PartnerPower of AttorneyChief Operating OfficerOtherCorp. Contact Email:*Enter the contact email. Corporate Address:* Corporate Address same as Business Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Corporate Phone:Enter the corporate phone. BANKING INFORMATIONBilling Type(s)*Select the billing type(s) to utilize this bank accountChecking AccountsCredit CardsChecking & Credit CardsBank Name:*Enter the name of your bank.Bank Routing Number:*Enter the Routing Number.Bank Account Number:*Enter the bank account number.Bank Phone Number.*Enter the bank phone number.Bank Account Title:*Enter the business name.Bank City:*Enter the city of the bank.Bank State:*Enter the state of the bank.AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificAuthorized Signer:*Enter the Name of authorized signer. First Last Authorized Signer's Email:*Enter the signer's email. * NO BANKING INFORMATION CHANGES BILLING INFORMATIONChecking Account Debits:*Do you want to debit Checking Accounts?Yes - Once a monthYes - Twice a monthYes - Three times a monthYes - Four times a monthYes - Daily or FrequentlyNo - Checking BillingChecking Date 1:Enter the date of the month for checking billing date #1 .NO Fixed Dates - Daily - Frequently1st of the month2nd of the month3rd of the month4th of the month5th of the month6th of the month7th of the month8th of the month9th of the month10th of the month11th of the month12th of the month13th of the month14th of the month15th of the month16th of the month17th of the month18th of the month19th of the month20th of the month21st of the month22nd of the month23rd of the month24th of the month25th of the month26th of the month27th of the month28th of the monthChecking Date 2:Enter the date of the month for the checking billing date #2.1st of the month2nd of the month3rd of the month4th of the month5th of the month6th of the month7th of the month8th of the month9th of the month10th of the month11th of the month12th of the month13th of the month14th of the month15th of the month16th of the month17th of the month18th of the month19th of the month20th of the month21st of the month22nd of the month23rd of the month24th of the month25th of the month26th of the month27th of the month28th of the monthChecking Date 3:Enter the date of the month for checking billing #3.1st of the month2nd of the month3rd of the month4th of the month5th of the month6th of the month7th of the month8th of the month9th of the month10th of the month11th of the month12th of the month13th of the month14th of the month15th of the month16th of the month17th of the month18th of the month19th of the month20th of the month21st of the month22nd of the month23rd of the month24th of the month25th of the month26th of the month27th of the month28th of the monthChecking Date 4:Enter the date of the month for checking billing #4.1st of the month2nd of the month3rd of the month4th of the month5th of the month6th of the month7th of the month8th of the month9th of the month10th of the month11th of the month12th of the month13th of the month14th of the month15th of the month16th of the month17th of the month18th of the month19th of the month20th of the month21st of the month22nd of the month23rd of the month24th of the month25th of the month26th of the month27th of the month28th of the monthResubmit NSF:*Checking returns for NSF Can be resubmitted for a second attempt at an additional per item fee.No - Do Not Resubmit Checking NSF ReturnsYes - I Want Checking NSF Returns to ResubmitCredit Card Debits:*Do you want to debit Credit Cards?Yes - Once a monthYes - Twice a monthYes - Three times a monthYes - Four times a monthYes - Daily or FrequentlyNo - Credit Card BillingCredit Card Date 1:Enter the date of the month for Credit Card billing date #1 .NO Fixed Dates - Daily - Frequently1st of the month2nd of the month3rd of the month4th of the month5th of the month6th of the month7th of the month8th of the month9th of the month10th of the month11th of the month12th of the month13th of the month14th of the month15th of the month16th of the month17th of the month18th of the month19th of the month20th of the month21st of the month22nd of the month23rd of the month24th of the month25th of the month26th of the month27th of the month28th of the monthCredit Card Date 2:Enter the date of the month for the credit card billing date #2.1st of the month2nd of the month3rd of the month4th of the month5th of the month6th of the month7th of the month8th of the month9th of the month10th of the month11th of the month12th of the month13th of the month14th of the month15th of the month16th of the month17th of the month18th of the month19th of the month20th of the month21st of the month22nd of the month23rd of the month24th of the month25th of the month26th of the month27th of the month28th of the monthCredit Card Date 3:Enter the date of the month for the credit card billing date #3.1st of the month2nd of the month3rd of the month4th of the month5th of the month6th of the month7th of the month8th of the month9th of the month10th of the month11th of the month12th of the month13th of the month14th of the month15th of the month16th of the month17th of the month18th of the month19th of the month20th of the month21st of the month22nd of the month23rd of the month24th of the month25th of the month26th of the month27th of the month28th of the monthCredit Card Date 4:Enter the date of the month for the credit card billlling date #4.1st of the month2nd of the month3rd of the month4th of the month5th of the month6th of the month7th of the month8th of the month9th of the month10th of the month11th of the month12th of the month13th of the month14th of the month15th of the month16th of the month17th of the month18th of the month19th of the month20th of the month21st of the month22nd of the month23rd of the month24th of the month25th of the month26th of the month27th of the month28th of the month * NO BILLING INFORMATION CHANGES PBFE AUTHORIZATIONConsent to Bank Account Activity:*I authorize Palm Beach Financial Exchange, Inc. (PBFE) to use this banking account to make deposits and withdrawals as necessary and consistent with the normal course of conducting the electronic processing NACHA debits and credits and/or the processing of credit card merchant services. I certify the banking information to be accurate and a legal account for the benefit of the named business named above. Account AuthoritySubmitted By:*Name of the person submitting this banking information. First Last Date Submitted:*Date information submittal.Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PhoneThis field is for validation purposes and should be left unchanged.
Palm Beach Financial Exchange, Inc.
Palm Beach Financial Exchange, Inc.