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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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AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS (ACH CREDITS) <br /> Company Name Company ID <br /> Number <br /> I (we)hereby authorize , hereinafter called COMPANY, to initiate credit <br /> entries to my (our) y Checking Account/ Y Savings Account (select one) indicated below at the depository <br /> financial institution named below, hereinafter called DEPOSITORY, and to credit the same to such account. I <br /> (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the <br /> provisions of U.S. law. I (we) acknowledge that a credit entry to my (our) account will add money to my (our) <br /> account subject to final settlement. <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 CREDIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE <br /> AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION. <br />
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