To submit this form, please ensure all required fields are completed accurately. You can upload the completed form using the Submit File feature in the Employer Portal, or return it to your MERS contact along with adoption documents. For any questions, you can contact Alerus Retirement Solutions at Two Pine Tree Drive, Suite 400, Arden Hills, MN 55112, fax at 651.746.6142, or through the online submission form on their website. It’s important to retain a copy of the completed form for your records.

There are no specific important dates for this form in 2024 and 2025 as the form can be submitted at any time when required.

The purpose of the ACH Debit Request Authorization Form is to facilitate the automatic transfer of funds from an employer's bank account to Alerus Financial for retirement plan contributions, including loan payments. This form ensures that the correct amount, as indicated in the payroll contribution file, is debited periodically from the employer's account. By completing and submitting this form, employers can streamline the process of managing retirement plan contributions and maintain accurate financial records. Furthermore, this authorization allows employers to adjust or correct any entries as needed, providing flexibility and ensuring the accuracy of transactions.

• 1. Employer name: The name of the employer authorizing the ACH debit.
• 2. Employer address: The address of the employer authorizing the ACH debit.
• 3. City: The city where the employer is located.
• 4. Phone: The phone number of the employer.
• 5. Email: The email address of the employer.
• 6. Program identification: Select the applicable program for the ACH debit.
• 7. Bank name: The name of the bank where the employer's account is held.
• 8. Retiree Health Funding Vehicle: The retiree health funding vehicle information.
• 9. Municipality number: The municipality number associated with the employer.
• 10. State: The state where the employer's bank is located.
• 11. Zip: The ZIP code of the employer's bank.
• 12. Bank address: The address of the employer's bank.
• 13. ABA/Routing number: The ABA/routing number of the employer's bank.
• 14. Account number: The account number of the employer's bank account.
• 15. Checking/Savings: Indicate whether the account is a checking or savings account.
• 16. Debit Block: Indicate if there is a debit block on the account.
• 17. Signature: The signature of the authorized employer representative.
• 18. Date: The date the form was signed.
• 19. Printed name: The printed name of the authorized employer representative.
• 20. Title: The title of the authorized employer representative.

Failure to submit this form may result in delays or interruptions to the automatic transfer of funds for retirement plan contributions.

• Delayed Contributions: Without this authorization, retirement plan contributions may be delayed.
• Manual Processing: Employers may need to manually process contributions, leading to increased administrative effort.
• Banking Information Errors: Incorrect or outdated banking information may result in failed transactions.

• 1. Authorizing ACH Debits: Authorize Alerus Financial to debit funds from your bank account via ACH.
• 2. Updating Banking Information: Update your banking information for ACH transactions.
• 3. Adding New Products: Add new products to your ACH transactions.
• 4. Managing Retirement Contributions: Streamline the process of managing retirement plan contributions.
• 5. Ensuring Accurate Records: Maintain accurate financial records for retirement plan contributions.