925 Boyson Ct Hiawatha ia 52233 (319) 393-4345 authorization agreement for direct payments (ach debits)




Yüklə 4.25 Kb.
tarix14.04.2016
ölçüsü4.25 Kb.



925 Boyson Ct Hiawatha IA 52233 (319) 393-4345

AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS)


Company Name: CRAG Gymnastic Company ID Number:
I (we) hereby authorize CRAG Gymnastics, hereinafter called COMPANY, to initiate debit entries to my (our) checking savings account (select one) indicated below at the depository financial institution named below, hereafter called DEPOSITORY, and to debit the same to such account. I (we) acknowledge that the origination of ACH transaction to
Depository Name: Branch:
City: State: Zip:
Routing Number: Account Number:
The authorization is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.
Name(s): ID Number:
Date: Signature:
NOTE: WRITTEN DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFIYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION


Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©azrefs.org 2016
rəhbərliyinə müraciət

    Ana səhifə