ACH Enrollment

ACH Enrollment Form - Port of Edmonds

Please complete the information below, and upload an image of your voided check. The Port will notify you when your ACH information has been accepted and when your ACH payments will begin. Please continue to pay your monthly balance until this time.

Name on Port of Edmonds Account *

Port of Edmonds Account # *

Phone *

Email *

Address

City

State/Province

Zip/Postal

Country

Routing Number *

Account Number *

Bank Name *

Terms and Conditions

I hereby authorize an automatic debit on the account designated above for the amount invoiced by the Port of Edmonds on the first day of each month. I understand that my account will be debited by an electronic bank draft on the 20th of the following month for the charges shown on that statement. I understand that any drafts returned for insufficient funds must be paid to the Port in the form of personal check, cashier’s check, or cash within 10 days of receiving notification from the Port. I agree to pay the NSF fee of $40.00.

*

I have read and agree to the ACH terms

Would you like to receive a monthly statement via email?

Please upload an image of your voided check *

Maximum file size: 52.43MB

Signature (draw in box) *

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