BankPac Prior Authorization Form

Please complete this form to allow BankPac to solicit voluntary contributions as outlined below.

For a printable version of this form, click here. You will need to download the form and fill it out using Adobe Acrobat Reader for the “Submit Form” button to work properly.

Questions? Contact Amy Heaslet at Amy Heaslet or call 615-244-4871


On behalf of my company, I authorize BankPac to solicit voluntary contributions from the executive and administrative personnel for the following years. SIGNATURE REQUIRED FOR EACH YEAR.
The Federal Election Commission requires members of the Tennessee Bankers Association (TBA) to sign this prior authorization form in order to be communicated with and solicited for BankPac, the association’s Political Action Committee (PAC).

Granting prior authorization to BankPac does not preclude employees of the company from contributing to other PACs, such as those supporting state or local candidates, as well as other national and ideological PACs. This authorization does not obligate you or anyone in your company to make a contribution. Permission may be withdrawn at any time.

If your company has given prior authorization to ABA, your company does not need to provide such authorization a second time to TBA.

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