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California State Teachers Retirement System Accounting Division Cash Receipts P.O. Box 15275 MS#12 Sacramento, CA 958510275ELECTRONIC PAYMENT AUTHORIZATION AGREEMENT FORM Print Forrest FormInstructions:
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How to fill out electronic payment authorization agreement

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How to fill out electronic payment authorization agreement

01
To fill out the electronic payment authorization agreement, follow these steps:
02
Begin by stating your personal information such as your name, address, contact details, and any other required identification information.
03
Provide the details of the payer, including their name, address, and contact information.
04
Specify the payment method you authorize, such as direct debit, credit card payment, or online banking transfer.
05
Include the necessary banking or financial institution information, such as your account number, routing number, or credit card details.
06
Clearly state the purpose or reason for the authorization agreement, such as paying a specific bill, monthly subscription, or recurring membership fees.
07
Indicate the start and end date for the authorization. Specify if it is a one-time payment or recurring payments.
08
Mention any limitations or restrictions on the authorization agreement if applicable.
09
Read and understand the terms and conditions thoroughly before signing the agreement.
10
Sign and date the agreement to acknowledge your consent and authorization.
11
Make sure to keep a copy of the filled-out agreement for your records and submit the original to the concerned party or institution.

Who needs electronic payment authorization agreement?

01
Any individual or entity that wishes to authorize electronic payments can benefit from an electronic payment authorization agreement. This includes:
02
- Individuals who want to set up automatic bill payments or recurring payments for their utilities, mortgage, loans, or subscriptions.
03
- Businesses or organizations that need to collect payments from their customers on a regular basis.
04
- Service providers who offer subscription-based services, rental properties, or membership fees and require authorization for recurring payments.
05
- Financial institutions or payment processors that require authorization agreements from their clients or customers to facilitate electronic fund transfers.
06
- Any party involved in a financial transaction that wishes to ensure secure and reliable payment processing while maintaining the necessary legal documentation.
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An electronic payment authorization agreement is a document that allows a payer to authorize a payee to electronically withdraw funds from the payer's bank account for payments like taxes or other obligations.
Businesses and individuals who wish to make electronic payments for taxes, fees, or other obligations to the government are required to file an electronic payment authorization agreement.
To fill out the electronic payment authorization agreement, you typically need to provide your personal or business information, banking details, payment amounts, and specify the type of payments you are authorizing.
The purpose of the electronic payment authorization agreement is to establish consent for electronic fund transfers and to ensure that funds can be withdrawn securely and efficiently.
The information that must be reported includes the payer's name, address, taxpayer identification number, bank account details, and the type of payments to be made.
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