Common Contracts
1 similar Payment Authorization Agreement contracts
DIRECT PAYMENT AUTHORIZATION AGREEMENTPayment Authorization Agreement • July 31st, 2017
I/We the undersigned account holder(s) hereby authorize payment of my/our extended care billing to St. Mary School of Manchester, IA. hereinafter called SCHOOL. I/We authorize the SCHOOL and the financial institution(s) listed below to initiate electronic debit entries, and if necessary, credit entries and adjustments for any debit entries in error to my/our checking/savings account(s). This authority will remain in effect until I have cancelled it in writing.
