AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS. □ I hereby authorize the initiation of a periodic deduction from my account at the financial institution named below through the ACH system and authorize said institution to debit my account for the amount and at the frequency set forth below. I acknowledge that this request does not violate the provisions of United States law as it applies to ACH transactions. I understand I have a right to stop this automatic payment by notifying either the institution named below or CFC, in writing, at least three (3) business days prior to the day my account is scheduled to be charged and that there may be a fee for that service. Further I agree that CFC will require written confirmation of an oral stop-payment order within fourteen (14) days. This will be a permanent stop payment on this preauthorized payment. I may, however, establish a new preauthorized payment from the same financial institution or company in the future. I also authorize adjustment entries in the event of erroneous transactions on my account. I agree to hold CFC harmless for any expenses, including fees, incurred as a result of its inability to process a scheduled preauthorized withdrawal due to: my having supplied incorrect information, its having acted on a stop payment order, or there being insufficient funds in the account I have indicated. IMPORTANT: PLEASE ATTACH A VOIDED CHECK WITH CORRECT ENCODINGINFORMATION Bank Routing Number: Depositor Account Number: Bank Name: Bank Address: IMPORTANT INFORMATION ABOUT YOUR ACCOUNT KEEP THIS INFORMATION FOR YOUR RECORD REVOLVING CREDIT AGREEMENT AND DISCLOSURE STATEMENT (HI RESIDENTS-CREDIT SALE CONTRACT) (RI RESIDENTS-NONNEGOTIABLE CONSUMER NOTE) Dealer may assign all rights under this Agreement and any credit sale made pursuant to it (as evidenced by a revolving credit sales slip) to Carmel Financial Corporation, Inc. (“CFC”) and to CFC’s further assigns. Interest Rates and Interest Charges Annual Percentage Rate (APR) for Purchases 17% - 17.99% (Maximum APR Varies By State. See table below *) Paying Interest Interest Charges begin on the date a purchase is posted to your account, except in states requiring a grace period, in which case your due date is at least 25 days after the close of each billing cycle and we will not charge you interest if you pay your entire balance by the due date. Minimum Interest Charge If you are charged interest, the charge will be no less than $0.50. For Credit Card Tips from the Consumer Financial Protection Bureau To le...
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS. Please sign and return with your payment. Be sure to use the checking account which you want to be debited for the CHECK-O-MATIC option. If payment isn’t due and you want to setup CHECK-O-MATIC for your next payment please send in a voided check from the account you want debited. Please circle the mode of payment and date the withdrawal is to be made. Monthly * / Quarterly / Semi-Annual / Annual, 1st, 5th or 15th of the Month. * Monthly payments are only permitted through CHECK-O-MATIC. I hereby authorize Royal Arcanum, to initiate debit entries to my Checking account indicated by the enclosed check. This authorization is to remain in full force and effect until Royal Arcanum has received written notification from me of its termination in such time and in such manner as to afford Royal Arcanum and Depository a reasonable opportunity to act on it. NAME ( Please Print Clearly ) DATE BANK NAME CHECKING SAVINGS BANK ROUTING NUMBER ACCOUNT NUMBER CERT NO. SIGNATURE PLEASE ATTACH YOUR VOIDED CHECK HERE 00 XXXXXXXXXXXX XXXXXX, XXXXXX, XX 00000 TOLL FREE 0-000-000-0000 TEL. 000-000-0000 FAX 000-000-0000
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS. Please sign and return with your payment. Be sure to use the checking account which you want to be debited for the CHECK-O-MATIC option. If payment isn’t due and you want to setup CHECK-O-MATIC for your next payment please send in a voided check from the account you want debited. Please elect the mode of payment and date the withdrawal is to be made by checking the boxes below. Premium Mode *Monthly Quarterly Semi-Annual Annual Debit Date 1st , 5th ,15th or 20th of the month. * Monthly payments are only permitted through CHECK-O-MATIC. By signing below, I authorize Royal Arcanum to debit my checking or savings account for the initial premium once my application has been approved by underwriting. I understand that the debit date elected above will be used for the initial premium as well as recurring premiums. *Please note for new business the initial debit date must be within 30 days from the date the application is signed. Please type or print all information clearly NAME DATE BANK NAME CHECKING SAVINGS BANK ROUTING NUMBER (9 DIGITS) / / / / / / / / ACCOUNT NUMBER CERT NO. SIGNATURE E-MAIL PLEASE ATTACH YOUR VOIDED CHECK HERE
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS. (ACH Debits) This agreement is hereby made by and between CONGREGATION B’NAI JEHOSHUA XXXX XXXXXX and . (Congregants name, please print) I (we) hereby authorize Congregation B’nai Xxxxxxxx Xxxx Xxxxxx to initiate debit (withdrawal) entries from my (our) Checking Account indicated below at the bank named below. Such transactions will be made at the interval and in the amount indicated below. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law. Bank Name: City: State: Zip: Routing No.: Acct. No.: Amount to be deducted monthly (quarterly) $ TOTAL FOR FISCAL YEAR 2024 – 2025 $ One of the following options must be checked: I would like to have payments deducted quarterly (July 15, Oct. 15, Jan. 15, and April 15) I would like to have payments deducted monthly (the 15th of each month, ending with the June payment) Date: Signature:
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS. I (we) hereby authorize the above checked parish to initiate debit entries to my (our) account, indicated below, from the depository financial institution named below; and to deposit the SAID AMOUNT CHECKED OFF BELOW to the said Parish’s Offertory account. I (we) acknowledge that the origination of EFT transactions by my (our) account must comply with the provisions of U.S. law. My (our) Financial Institution Name City/State , The Financial Institution Routing Number Checking Acct. Number or Savings Acct. Number
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS. YINGHUA ACADEMY I (we) hereby authorize _______________________________, hereinafter called COMPANY, to initiate debit entries to my (our) Checking Account/ Savings Account (select one) indicated below at the depository financial institution named below, hereinafter called DEPOSITORY, and to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law. Depository Financial Institution Name ____ Routing Account Number___ Number_____________________________ This 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)_____________________________ Date__________________________ Signature __________________________________________
