ACH Origination Application

If you do not understand any part of the following information, an employee at any branch or at Customer Service will be happy to assist you. Phone calls may be monitored or recorded for quality control purposes. Customer Service phone numbers are as follows: 1-800-342-0679 and 1-361-275-2345.

Required Field

Employee Information

Do you perform background checks on new employees?

Is a photo ID required for employment?

Are photo IDs worn in the workplace?

Primary Applicant

Enter the name of the person authorized to agree to the contract later in the application.

Authorized Person Authorized Person's Title Social Security Number Email

Users

Primary User

Name Title Business Phone Business Fax Email Social Security Number

 Add Another User

Account and ACH File Transfer Information

To open an account contact your nearest TrustTexas Bank branch location.

Account Number

Please estimate the following information

When will transfers be made? (Ex Monthly, Weekly, Bi-Weekly) Schedule of Transfers (Ex Every Monday, 15th of every month ect) Average Dollar amount of transfer Number of employees/customers

What type of files will you be processing?

Credit Files
Debit Files

What type of software will you be using?

Third Party software
Bank's software

IT Information

Do you have wireless Internet access?

Is it a secured wireless connection?

What operating systems do you use on computers connected to the scanners?

Windows 7
Windows 10
Other

Please List

Do you keep updated antivirus software on your computers?

Do all computers use a firewall?

Do you perform IT audits?

If yes, please supply financial institution with a copy of latest audit.

Do you have IT staff onsite?

Do you offer VPN or remote access for staff?

Tokens

How many tokens are needed? Each person must be assigned their own token to originate ACH File Transfers.

Token User

Name Phone Email

 Add Another Token

Endorsement

I certify that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. I authorize the Financial Institution to make any credit or investigative inquiry that the Financial Institution determines appropriate. I understand that I must update the information listed above at your request and if my financial condition changes. Primary Applicant's Signature Date