ACH Authorization Form

For custom shipping crate, packaging, and related pre-arranged KCR Industries orders.

KCR Industries

Business Office Address
777 Main Street
Suite 600
Fort Worth, Texas 76102

Correspondence Address
PO Box 136932
Fort Worth, Texas 76136

Phone: 817-264-6040

Use this form only for authorized KCR Industries payments.
Required fields are marked with a red asterisk.
Routing and account numbers must be entered twice for confirmation.

Payment authorization notice: Submit this form only when you are authorizing KCR Industries to draft the listed amount for a specific invoice or pre-arranged order.

ONE-TIME ACH PAYMENT AUTHORIZATION

Name: KCR Industries
Price range: $$

Authorization for a specific KCR Industries invoice or pre-arranged order

Fort Worth, Texas • 817-264-6040 • Sales@KCRIndustries.com

* KCR Invoice Number

* Amount To Draft

* Your Company Name

* Your Name / Electronic Signature

* Bank Name

* Bank Routing Number

* Re-Enter Bank Routing Number

Bank routing numbers must contain exactly 9 digits and both entries must match.

* Bank Account Number

* Re-Enter Bank Account Number

The account numbers do not match.

* Email Address

* Phone with Area Code

Other Notes or Comments

* Voided Check or Deposit Slip

Upload a clear PDF or photo showing the bank routing and account information for this one-time order payment.

Choose File or Take PhotoNo file selected

Accepted: PDF, JPG, JPEG, PNG, HEIC, or HEIF. Maximum 10 MB. JPG/PNG photos can be cropped before submission.

* Government-Issued Photo ID

Upload a clear scan or smartphone photo of a current driver's license, state ID, passport, or military ID.

Choose File or Take PhotoNo file selected

Enhanced Identity Verification (Optional, Recommended)

For additional fraud protection, please provide a current photo of yourself holding the same photo ID uploaded above.

Choose File or Take PhotoNo file selected

I prefer not to provide an additional identity-verification photo.

One-Time Authorization: I authorize KCR Industries to initiate a one-time ACH debit from the bank account identified above for the specific KCR invoice/order and amount shown on this form. This authorization is limited to that payment and does not authorize recurring debits. By submitting the electronic form, I certify that I am the account owner or an authorized signer and that the supporting documents submitted relate to the account and identity information provided.

Submitting this form securely sends the one-time ACH authorization and supporting documents to KCR Industries. Original uploads are retained;

For recordkeeping, the server creates a unique submission ID and records the server receipt time, IP information, browser/device information, referring page, screen/language information, and SHA-256 fingerprints of the uploaded supporting documents. A professional authorization PDF and a separate audit-report PDF are included with the emailed submission.

Optional device location: When you submit, you will be asked to choose whether to share this device's location or continue without sharing. If you choose to share, your browser may also ask for permission. Existing browser settings can prevent location access. Your authorization can be sent either way. If shared, the approximate coordinates, reported accuracy and time will be included in our private submission audit records for fraud review. Device location can be inaccurate or spoofed.

ACH authorization for approved custom crate orders.

Before submitting

ACH Authorization Form

KCR Industries

ONE-TIME ACH PAYMENT AUTHORIZATION

Questions before authorizing payment?