ACH Form

Dear Supplier,

As a Rackspace supplier your organization is strongly encouraged to take advantage of the ACH Payment (Automated Clearing House) program. ACH is a more convenient way for your organization to receive direct payments as they are not subject to handling and mailing delays associated with checks. In addition, ACH payments are automatically and securely deposited into your organization’s designated bank account and are sheltered from opportunities for misrouting, theft, and forgery.

To begin receiving direct deposit payments, please complete the form below and return this entire page:

By Mail: Attention Accounts Payable, Mail Stop# US-101-1705 (Address on the bottom of this page).

Fax: 210-312-5043

If you have any questions please call (210) 312-5852

AUTHORIZATION AGREEMENT FOR ACH (AUTOMATED CLEARING HOUSE) DEPOSITS

Company Name:
_______________________________________________________________________________

Remittance Address:
_______________________________________________________________________________

E-mail Address:
_______________________________________________________________________________

Rackspace acknowledges that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. Law.

Bank Name:
_______________________________________________________________________________

Branch:
_______________________________________________________________________________

City:
_______________________________________________________________________________

State:
_______________________________________________________________________________

Zip:
_______________________________________________________________________________

Account Name:
_______________________________________________________________________________

Routing Number:
_______________________________________________________________________________

Account Number:
_______________________________________________________________________________

This authorization is to remain in full force and effect until Rackspace has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Rackspace and me (or either of us) a reasonable opportunity to act on it.

Name:(Please Print)
_______________________________________________________________________________

Title:
_______________________________________________________________________________

Telephone Number:
_______________________________________________________________________________

Date:
_______________________________________________________________________________

Signature:
_______________________________________________________________________________

For AP use only:  Vendor Number___________