CAA USA ACH Enrollment Form

Children's Adoption Aid
Automatic Payment Authorization Form

To enroll in the automatic payment program and have your monthly shares deducted from your bank account, fill out the form below and submit along with an uploaded image of a voided check.

I authorize CAA to charge my monthly payment to my bank account number shown above. This also includes authorization to charge to my bank account any past due balance on my CAA account. I understand the funds will be withdrawn on the twenty-second day of each month and that it is my responsibility to ensure sufficient funds are in my account at that time.

I understand that if my total payment amount changes due to changes in my policy with CAA, I will receive notice from CAA and they will withdraw the new amount on the effective date of such change unless otherwise instructed by me.

This authority will remain in effect until I instruct CAA to cancel or change it. Future authorization must be in writing and must be received by CAA seven days prior to the first day of the effective month. I also understand that if my payment is returned for “Not Sufficient Funds”, CAA may discontinue this service at their discretion. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of the U.S. law.

Please upload an image of a voided check from the bank account to be debited for your monthly payment.
Drop a file here or click to upload Choose File
Maximum upload size: 15MB