Common Contracts
1 similar Ach Debit Authorization Agreement contracts
ACH Debit Authorization AgreementAch Debit Authorization Agreement • August 3rd, 2010
AUTHORIZATION AGREEMENT FOR PRE-ARRANGED PAYMENTS (ACH DEBITS) Company Name: Concord Dance Academy (herein referred to as “Company”)Address: 26 Commercial St, Concord NH 03301Company ID: I (we) hereby authorize Company to initiate debit entries to my (our) Checking/Savings Account indicated below and the depository named below, hereinafter called Depository, to debit the same to such account. Depository Name: Branch City: State Routing/Transit # (ABA) Checking Account #: Savings Account #: Begin Date: Termination Date: Recurring Amount: $ This authorization is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it. Depositor Name: Depositor Name: Signature Date Signature Date NOTE: WRITTEN DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN
