Common Contracts

AUTHORIZATION AGREEMENT FOR ACH Payments

March 27th, 2014

• Filed
  March 27th, 2014

For the purpose of paying (my/our) monthly water bill (I/we) do hereby authorize Hiland Water Corp hereinafter named the COMPANY, to initiate recurring debit entries to (my/our) (Checking Account / Savings Account) as indicated and named below as the depository financial institution, hereafter named FINANCIAL INSTITUTION. (I/we) acknowledge that the origination of ACH transactions to my (my/our) account must comply with the provisions of U.S. law. Furthermore, if any such debit(s) should be returned NSF, (I/we) authorize the COMPANY to collect such debit(s) by electronic debit and subsequently collect a returned debit NSF fee of $25.00 per item by electronic debit from my account identified below.