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Instructions for completing the form

ACH Payment Enrollment Form

* Indicates required field
* Type of Transaction

SECTION 1 (To be completed by the supplier)
* Account Type
Supplier Certification
By submitting this form, I authorize payments to be sent to the financial institution named above and to be deposited to the designated account

SECTION 2 (To be signed by supplier or delegate to CANCEL payment via ACH)


The information on this form is confidential and is required to process payment data from the Research Foundation of SUNY to the financial institution and/or its agent. Failure to provide the requested information may delay or prevent receipt of payments through the ACH program.

Cancellation of ACH Payments:

Payments will be made electronically via ACH until cancellation by the Research Foundation or the supplier.

Cancellation by the Research Foundation:   ACH payments will be canceled on the effective date of any of the following:

    • Change of financial institution or account information

    • Change of the supplier to inactive status.

Cancellation by the Supplier:  You may stop receiving payments via ACH at any time by completing a new ACH Payment Enrollment Form. On a new form, check the Cancel box, fill in supplier name, Identifying number and account type, then sign and date the form in Section 2.

Change in Financial Institution:

To change the financial institution into which you deposit funds, you must first cancel your ACH payment (see above), then complete a new enrollment form to start ACH payments with the new financial institution.


• You are responsible for verifying (with your bank) the accuracy of your bank account number when your enrollment form is completed

• You are responsible for notifying the Research Foundation if you change banks or account number. You must complete a new ACH Payment Enrollment Form and begin the ACH payment process again.

• You must complete a ACH Payment Enrollment Form to cancel that ACH payment (see above for cancellation instructions).

• You are responsible for payment of any charges that may be incurred against your account as a result of receiving an ACH payment.

• You must repay the Research Foundation of SUNY if an overpayment occurs as the result of payment via ACH.


A pre-notification will be processed upon receipt of this ACH Payment Enrollment Form to verify banking information is correct. If any problems occur during the processing of the pre-notification supplier payments will continue as they were prior to completing the ACH Payment Enrollment Form until corrections can be made.

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