It is a part of the municipality of West Betuwe, and lies about 12 km (7 mi) east of Gorinchem.

According to popular legend a "Jan van Arkel" was the first to have settled the village of Acquoy, when he returned from the crusades in 1133.

After Acquoy changed hands several times, it was bought by Floris van Egmond, Count of Buren, in 1513.

The village got its typical long stretched form, parallel to the river, because people used to build their houses on, or directly behind, the Linge dike.

Others point out that "Acquoy" is mentioned in old scripts as Eckoy or Echoy and this would mean that it was the lowland of lord Akko or Ekko.