ACH DEBIT PAYMENT METHOD Sample Clauses

ACH DEBIT PAYMENT METHOD. I understand that once this authorization agreement is approved by the California Department of Insurance (CDI), I will be provided a temporary security code and a company identification number. I am then required to go to First Data’s payment website at ▇▇▇.▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇ to complete the remaining registration by adding my payment information, which includes bank account number and routing number, before any invoice payments can be initiated by me or the EFT contact person listed above. This authorization agreement is to remain in full force until EFT payments are no longer required or until CDI and I mutually agree to terminate my voluntary participation in the EFT program. The person named below has authority to approve the use of EFT transactions for the payment of balances due to CDI. SIGNATURE OF REPRESENTATIVE TITLE OF SIGNER DATE PRINT NAME OF SIGNER EMAIL ADDRESS (Required) PHONE NUMBER A copy of this agreement will be returned confirming your enrollment along with instructions on how to create a user profile to begin using the EFT system.

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