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2000_0828_packet
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2000_0828_packet
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9/29/2011 10:04:38 AM
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Schedule D: ACH Sample Authorization Agreements <br /> AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS) <br /> Company Name Company ID Number <br /> I(we)hereby authorize , hereinafter called COMPANY, to initiate debit entries to <br /> my (our) y Checking Account/ y Savings Account (select one) indicated below at the depository financial <br /> institution named below, hereinafter called DEPOSITORY, and to debit the same to such account. I (we) <br /> acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of <br /> U.S. law. I (we) acknowledge that a debit entry to my (our) account will remove money from my (our) account. <br /> Depository <br /> Name Branch <br /> City State Zip <br /> Routing Account <br /> Number Number <br /> This authorization is to remain in full force and effect until COMPANY has received written notification from <br /> me (or either of us) of its termination in such time and in such manner as to afford COMPANY and <br /> DEPOSITORY a reasonable opportunity to act on it. <br /> Name(s) ID <br /> Number <br /> Date Signature <br /> NOTE: ALL WRITTEN DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION <br /> ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION. <br />
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