SHP ACH/Check Request Form

SHP ACH/Check Request Form
Your Name*

First NameLast Name
Your Email*
example@shpbeds.org
Your Phone Number*
Please enter a valid phone number.
Select your Chapter*
Chapter Region
What payment method do you need?*

CheckACH
Name of the business/organization/person we're making this payment to*
Business/Organization/Person Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is the address we're mailing this check to different than the address you just provided?*

YesNo
Who are we mailing this check to?*
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Please upload the payee's bank information*

Institution name, account number, routing number, etc.
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Please provide the Business/Organization/Person's email address we can send ACH remittance information to*
ACH/Check Amount*
Is this a recurring payment?*

YesNo
How frequently does this need to be paid?*
Will this amount change?*

YesNo
Please explain why this payment amount will change.*
Is this related to a lease of any kind?*

YesNo
Is this a new or existing lease?*

New leaseExisting lease
If this payment is related to a new lease that has not yet been approved by CSC, this payment request will be rejected.
Please upload a copy of the signed lease*

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Please explain the purpose of this payment.*
Provide as much information as possible
Please upload the related invoice*

If you don't have an invoice, we cannot complete this request.
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Have you provided the Finance team with a W-9 for this payment already?*

YesNo
If the Finance Team does not have the W-9 for this payment already, this payment request will be rejected.
Please upload the related W-9*

If you do not have a W-9, we cannot complete this request.
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