ACH ORIGINATION APPLICATION
Submitter Information
First Name (required)
Last Name (required)
Resolve the errors marked in red before submitting again.
Company Information
Legal Name of Business
 
Company/Doing Business As
 
Website Address
 
Number of years in business
 
Number of years at TrustTexas Bank
 
Business Address (required)
Mailing Address (if different from Business Address)
Business PhoneBusiness FaxPrimary Applicant's Direct PhoneFederal Tax ID

 
Do you offer products and services outside the United States?
Have you filed for bankruptcy in the past seven years?
Does your company currrently use our Business Internet Banking system? (required)
Does your company currently use our Merchant Deposit services?
Do you perform background checks on new employees?
Is a photo ID required for employment?
Are photo IDs worn in the workplace?
Enter the name of the person authorized to agree to the contract later in the application.
Primary Applicant
Authorized Person
 
Authorized Person's Title
 
Social Security Number
 
Email
 
Primary UserAdditional User 1Additional User 2Additional User 3
Name
 
Title
 
Phone
 
Fax
 
Email
 
Social Security Number
 
To open an account contact your nearest TrustTexas Bank branch location.
Account Number
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, etc)
 
Average dollar amount of transfer
 
Number of employees/customers
 
What type of files will you be processing? (required)
What type of software will you be using? (required)
Do you have wireless Internet access?
What operating systems do you use on computers connected to the scanners?
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?
Each person must be assigned their own token to originate ACH File Transfers.
How many tokens are needed?
 
Token User 1Token User 2Token User 3Token User 4
Name
 
Phone
 
Email
 
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 SignatureDate