FUNDS TRANSFER AUTHORIZATION AGREEMENT. Completing this Funds Transfer Authorization Agreement (hereinafter “Authorization Agreement”) allows Company to collect premium payments electronically from a bank account designated by Producer. Producer may establish a new account solely for Company premium collection, or use and existing escrow account. Producer hereby authorizes Company to initiate DEBIT and CREDIT entries to the account indicated below at the financial institution named below, hereinafter referred to as “Depository.” Producer further authorizes Depository to accept such automatic deposits to or withdrawals from Producer’s account by Company and to automatically credit or debit, as the case may be, such amounts. Depository Name: Branch Name: City, State, Zip: Telephone: Routing Number: Account Number: Account Type: Producer Name: Producer Code: This authorization is to remain in full force and effect until Company has received written notification from Producer of its termination in such time and manner as to afford Company and Depository a reasonable opportunity to process the termination. If there is a change in any of the information relating to the account name, number, or address provided by Producer in this Authorization Agreement, Producer agrees to notify Company within ten (10) days of such change. Producer further agrees to notify Company within two (2) days if the account listed above is closed, seized, or frozen, or any other action is taken upon the account by Depository or any other entity that would affect the debiting or crediting of funds to the account. This Authorization Agreement is non-negotiable and non-transferable. Producer authorizes Company to debit and credit the account listed above periodically in variable amounts as may be necessary to affect any Producer Agreement Producer has entered into with Company. Producer Signature: • PLEASE ATTACH A VOIDED CHECK FUNDS TRANSFER CANNOT BE ACTIVATED WITHOUT A VOIDED CHECK
FUNDS TRANSFER AUTHORIZATION AGREEMENT. Completing this Funds Transfer Authorization Agreement (hereinafter referred to as “Authorization Agreement”) allows Company to directly deposit commission checks electronically into a bank account designated by the Producer. Producer hereby authorizes Company to CREDIT entries to the account indicated below at the financial institution named below hereinafter referred to as “Depository.” Depository Name Telephone Routing Number Account Number Producer Name Producer Code: (Avatar completes) This authorization is to remain in force and effect until Company has received written notification from Producer of its termination in such time and manner as to afford Company and Depository a reasonable opportunity to process the termination. Producer Signature: PLEASE ATTACH THE FOLLOWING:
