SRC-003 — U.S. Payment Authorization Form

Option 1: Download blank fillable PDF — open and complete in Adobe Acrobat. Option 2: Fill here, then print/save as PDF.

Dear valued business partner,

We ask for your cooperation filling out the information requested on this form. Completion of this form and the procedure outlined below is designed to protect both parties from unauthorized transactions. Please verify instructions submitted for payment by completing the following process:

Complete all information in the form below.
ACH, Single Use Accounts ("SUA") and Wire Transfers are the preferred methods of payment. ACH and SUA transactions can be done at no cost to your company. Wire transfers will require an additional bank charge deducted from payment. Checks are highly discouraged due to the higher risk of fraud — if a check is required, document the reason below.
This form must be signed by two authorized officers of your company.
Wahl will perform callback verification before activating the account.
A small test amount will be sent to the account. Verification of receipt must be confirmed by one of the two signing officers within 5 business days, or no further remittances will be sent.

Banking Information

Company Legal Name *

Bank Name *

ABA Routing Number *

Account Number *

SWIFT Code (wire transfers)

Method of Payment *

ACH Checking Preferred Wire Transfer Single Use Account (SUA) Preferred Check (discouraged — requires justification)

Reason Check Cannot Be Avoided *

Authorized Signatures — Two Officers Required

Important: This form must be signed by two separate authorized officers of your company. A single signature is not sufficient. Both signatories will be subject to callback verification by Wahl Finance before the payment method is activated.

Authorized Officer 1

Printed Name *

Title *

Date Signed *

Signature *

Authorized Officer 2

Printed Name *

Title *

Date Signed *

Signature *

Return Instructions: Send the completed and signed form to BankAccountRequest@wahlclipper.com. For questions about this form or the payment setup process, contact AP-Invoices@wahlclipper.com. Do not send banking information through any other channel — Wahl will only accept banking details via this form and verified callback process.

Verification Step	Result / Date
Vendor Code
Payment Method Approved?
Test file sent and receipt authenticated
Callback verification completed