Electronic Funds Transfer (EFT) Authorization Form

Please complete the EFT form so that we can process your electronic payment. Note: This is for ACH payment type only and not wire transfer. If you have any questions, contact Grants@cicf.org.

Please DO NOT click the Submit button twice. Wait after you click Submit for the page to load. Once the form is submitted, you will receive an on-screen confirmation message as well as a confirmation email.

Per an update to our policy in September 2025, we are now requiring a copy of a voided check tied to the bank information you provided above. You cannot attach a voided check to this form, so a member of our accounting team will follow-up with instructions.

EFT Authorization Form

Your Organization's Information

Email Address
Confirm Email Address
Organization Mailing Address
Organization Mailing Address
Address Line 1
Address Line 2
City
State/Province
Zip/Postal
Please enter the name of the staff member you are working with on this grant. If you are unsure, please type N/A.

Financial Institution's Information

For ACH payment type only NOT wire transfer.
Enter Account Number
Confirm Account Number
Enter Routing Number, with no spaces or dashes
Do you authorize the CICF Collaborative to initiate an electronic credit entry to this checking account? *
By checking this box, you acknowledge that the origination of ACH transactions (electronic payment) to my account must comply with the provisions of U.S. law. This authority will remain in effect until I have cancelled it in writing.

Per an update to our policy in September 2025, we are now requiring a copy of a voided check tied to the bank information you provided above. You cannot attach a voided check to this form, so a member of our accounting team will follow-up with instructions.