Common Contracts
1 similar Ach Debit Authorization Agreement contracts
ACH Debit Authorization AgreementAch Debit Authorization Agreement • April 11th, 2011
Step 1: Fill out and complete formStep 2: Print and Fax form to 404-832-4090 Reset Form Print Form Complete this form if you want us to debit your account at another institution. (You must be an account-holder on the account being debited.)New Authorization Change Authorization ( Bank Frequency Amount) Cancel Authorization for $ Debit Instructions Please debit my account at the Financial Institution listed below: FINANCIAL INSTITUTION NAME AMOUNT TO DEBIT$ ROUTING NUMBER CHECKING ACCOUNT NUMBER LIST NAME(S) OF ALL ACCOUNT-HOLDER(S) ACH DATE (MM/DD/YY)Begin Cancel FREQUENCY OF DEBITWeekly (Indicate day) M T W TH FMonthly (Indicate date 1st - 27th or last day of the month) Other (Please describe) Note: If the date you have requested the ACH transaction to occur is on a weekend or holiday, the transaction will occur the previous business day. Credit Instructions Please credit my GreenSky HIF account number (last 10 digits): LIST NAME(S) OF ALL ACCOUNT-HOLDER(S) Authorization You
