AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFER (EFT-1)Authorization Agreement for Electronic Funds Transfer (Eft-1) • January 4th, 2007
Complete Section I Below: Branch # 000000 Please Check Appropriate Boxes New EFT AccountChange EFT Remittance Method Change Bank AccountChange in Holder Contact Information HOLDER INFORMATION FEDERAL EMPLOYER ID# (FEIN): - NAME ADDRESS CITY STATE ZIP UNCLAIMED PROPERTY HOLDER TYPE CODE PHONE ( _ _ _ ) _ _ _ - _ _ _ _ EXT CONTACT INFORMATION - REPORT FILER NAME EMAIL PHONE ( _ _ _ ) _ _ _ - _ _ _ _ EXT FAX ( _ _ _ ) _ _ _ - _ _ _ _ Complete Section II, III or IV Below: SECTION II ACH DEBIT If you have selected the ACH Debit option, you MUST either attach a voided check OR a letter, on company letterhead, noting your Bank Transit Routing Number and Bank Account Number.This information will be used only to verify bank account, transit and routing numbers. BANK NAME: BANK ACCOUNT NUMBER (not to exceed 17 digits): TRANSIT AND ROUTING NUMBER: (not to exceed
