How to Fill Out and Submit a Pre-Authorized Payment (PAD) Form

To fill out a pre-authorized payment form, write in your full legal name and address, your bank’s nine-digit routing number, your checking or savings account number, the payment amount and frequency, and your signature and date; attach a voided check if the form asks for one, and return it to the company through the channel they specify. Federal law requires the authorization to be in writing and requires the company to give you a copy for your records.¹

What to Have in Front of You

Before you start writing, pull together your banking details. Every form asks for the same two core numbers: your bank’s nine-digit routing number and your account number. The routing number identifies your bank inside the ACH network. The account number points to your specific checking or savings account.

The quickest place to find both is on a personal check. The routing number is the first set of digits printed along the bottom left; the account number is the longer set immediately after it.² No checks on hand? Log into your bank’s online portal or mobile app; most display both numbers on the account details screen. You can also call the bank and have a representative read them to you.

Many forms also ask for a voided check or a bank-issued direct deposit verification letter stapled or uploaded with the form. The voided check gives the payee a physical reference to cross-check what you wrote, which cuts down on data-entry errors. To void a check, write “VOID” in large letters across the front. Never sign it.

Completing Each Field

The layout varies from company to company, but the fields are mostly the same.

Account holder name. Your full legal name as it appears on the bank account. Joint accounts may require both names.
Address and phone number. Your current residential address and a phone number the company can use for verification.
Bank name and branch. The name of your financial institution and, on some forms, the branch city or address.
Routing number. The nine-digit ABA routing number for your bank.³
Account number. Your checking or savings account number.
Account type. Checking or savings. Money market accounts can also accept ACH debits, though some banks impose per-month transaction limits on them.
Payment amount and frequency. Whether the withdrawal is a fixed dollar amount each cycle or varies based on usage or balance, and the schedule — weekly, biweekly, monthly, or another interval.
Signature and date. Federal law requires your written or electronic signature to authorize recurring debits from a consumer account.¹

Double-check every digit in the routing and account numbers. Transposing a single digit can route the payment to the wrong account, trigger a return, and leave you with a missed-payment notice from the company. Some forms include a disclosure about the Electronic Fund Transfer Act. Signing means you acknowledge those terms; the law requires the company to give you clear disclosures before the first debit hits.⁴

Submitting the Form

Return the completed form through whatever channel the company provides: an online portal, email upload, fax, or physical mail. If you mail a paper copy, certified mail gives you proof of delivery. Ask for a copy of the signed authorization if the company doesn’t send one automatically; they’re required to give you one.¹

Before the first real withdrawal, some companies send a prenotification — often called a “prenote” — through the ACH network. It’s a zero-dollar test transaction that confirms your routing and account numbers are valid and the account is open. Prenotes are optional under Nacha rules, so not every company uses them.⁵ If yours does, expect a few business days between the prenote and the first real debit.

You should receive a confirmation notice telling you when the first withdrawal will post. Note that date. If you’ve been paying manually, stop those payments before the automatic debits start so you don’t pay twice in one cycle.

When the Amount Changes Each Cycle

If your authorization covers payments that change from month to month, like a utility bill based on usage, the payee or your bank must send you written notice of the upcoming amount and date at least 10 days before each transfer.⁶ The company can offer you the option of receiving notice only when the amount falls outside a range you agree to in advance. That cuts down on paperwork while still flagging unusually high charges.

Updating Bank Details Later

If you switch banks, get a new account number, or want to change the withdrawal date, submit a revised authorization to the payee. Contact their billing department and ask for the update process. Some provide an online form; others require a new paper authorization with a fresh signature.

Timing matters. Submit the change well before your next scheduled debit. If the old account has been closed or lacks funds when the next withdrawal hits, the transaction bounces back as a return, and you could face fees from both your bank and the payee. Give yourself a buffer of at least a full billing cycle when possible.

Cancelling the Authorization

You have a federal right to stop any preauthorized debit from your account. To exercise it, notify your bank orally or in writing at least three business days before the scheduled transfer date.¹ The bank must honor that request, and if the debit is resubmitted, it must keep blocking it until you say otherwise.⁷

Oral stop orders have a catch. If you call the bank to stop a payment, the bank can require written confirmation within 14 days. Miss that deadline and the oral order expires; the bank is free to let future debits go through.⁶ Always follow up in writing. This is where most cancellations fall apart.

If the recurring charge is permanent, say you’ve left a gym or cancelled an insurance policy, also send a separate revocation letter to the payee stating that you’ve withdrawn your authorization. Your bank can ask you for a copy of that revocation as proof. Stopping the automatic withdrawal doesn’t cancel the underlying service or debt. You may still owe money, and the company may pursue it through other collection methods. Handle the service cancellation separately.

A Note on Business Accounts

The consumer protections above — the stop-payment rights, the disclosure and notice requirements, the error-resolution procedures — apply only to accounts established primarily for personal, family, or household purposes.⁸ Business accounts fall outside Regulation E. If you’re authorizing debits from a business account, your rights depend on the deposit agreement with your bank and your contract with the payee. Read the commercial account agreement before you sign.

1
Office of the Law Revision Counsel. 15 USC 1693e – Preauthorized Transfers
2
Nationwide. Locate Routing and Account Numbers on a Check
3
U.S. Bank. U.S. Bank Routing Number
4
Consumer Financial Protection Bureau. 12 CFR 1005.7 – Initial Disclosures
5
Nacha. Minor Rules Topics
6
eCFR. 12 CFR 1005.10 – Preauthorized Transfers
7
Consumer Financial Protection Bureau. Comment for 1005.10 Preauthorized Transfers
8
Consumer Financial Protection Bureau. 12 CFR 1005.2 – Definitions