Authorization Agreement for Pre-Authorized Payments (ACH Debits)Authorization Agreement for Pre-Authorized Payments (Ach Debits) • August 16th, 2023
HARVEST-MONROVIA WATER AUTHORITY, INC.Authorization Agreement for Pre-Authorized Payments (Ach Debits) • August 9th, 2004
AUTHORIZATION AGREEMENT FOR PRE-AUTHORIZED PAYMENTS (ACH DEBITS)Authorization Agreement for Pre-Authorized Payments (Ach Debits) • November 23rd, 2016
ContractAuthorization Agreement for Pre-Authorized Payments (Ach Debits) • August 9th, 2019
AUTHORIZATION AGREEMENT FOR PRE-AUTHORIZED PAYMENTS (ACH DEBITS) Moffat Water Supply Corporation 5456 Lakeaire Blvd. Temple, Texas 76502 254-986-2457 I (we) hereby authorize Moffat Water Supply , hereinafter called MWSC, to initiate debit entries from my (our) [ ] checking [ ] savings account (check one) indicated below and the depository named below, hereinafter called DEPOSITORY, to debit the same to such account. DEPOSITORY/BANK NAME: CITY ADDRESS: STATE: ZIP: ROUTING NUMBER: ACCOUNT NUMBER: This authority is to remain in full force and effect until MWSC has received notification from me (or either of us) of its termination in such time and in such manner as to afford MWSC and DEPOSITORY a reasonable opportunity to act upon it. NAME(S): MWSC ACCT NUMBER: DATE: SIGNATURE:
AUTHORIZATION AGREEMENT FOR PRE-AUTHORIZED PAYMENTS (ACH DEBITS)Authorization Agreement for Pre-Authorized Payments (Ach Debits) • July 29th, 2019
NURSING FACILITY QUALITY ASSESSMENTAuthorization Agreement for Pre-Authorized Payments (Ach Debits) • July 11th, 2008
STEP 1 NURSING FACILITY NAME FEDERAL EMPLOYER IDENTIFICATION NUMBER FACILITY NAME & ADDRESS NUMBER AND STREET ADDRESS ADDRESS (continued) CITY/TOWN STATE & ZIP CODE STEP 2 INITIAL, CHANGE, OR Check the type of request: INITIAL REQUEST CHANGE REQUEST REVOKE AUTHORIZATION REVOCATION STEP 3 DEPOSITORY (BANK) INFORMATION DEPOSI- TORY INFORMA- TION Depository (Bank ) Name Depository (Bank)Routing& Transit # Name on Depository Account FEIN/SSN on Depository (Bank)Account DepositoryAccount Account Type Savings Checking Number (check one) YOU MUST PROVIDE A COPY OF A VOIDED CHECK OR A SAVING WITHDRAWAL SLIP FOR THIS ACCOUNT. STEP 4ACH AUTHO- RIZATION This authorization is to remain in full force and effect until the STATE has received written notice from me (or either of us) of its termina- tion in such time and in such a manner as to afford the STATE and DEPOSITORY a reasonable opportunity to act on it.By signing below, I hereb
AGREEMENT FOR PRE-AUTHORIZED PAYMENTS (ACH DEBITS)Authorization Agreement for Pre-Authorized Payments (Ach Debits) • September 11th, 2016
