Common Contracts
1 similar Authorization Agreement for Preauthorized Payments contracts
AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTSAuthorization Agreement for Preauthorized Payments • September 26th, 2006
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). The information requested on the form is required under various provisions of title 15 U.S.C. 1601, 12 CFR 205, and 31 CFR 202, for the purpose of providing authority to the Department of Treasury to designate financial institutions to collect payments, by electronic means, from your account. The information will be used for identification with the records of the government agency and the financial institution to direct your payments to the point you authorize. No deduction maybe made unless a signed authorization form is received. Failure to furnish this information may delay or prevent the collection of these payments through the Automated Clearing House System.
