Financial Institution Name. City: State: Zip: Transit/ABA No: Account No: This authority is to remain in full force and effect until the Association and the Financial Institution have received written notification from me of its termination in such time and manner as to afford the Association and the Financial Institution a reasonable opportunity to act upon the request. I further understand that payments will be deducted from my account between the first (1st) and tenth (10th) of each month in which the assessment is due, and should my payment be returned for any reason, I understand that I can be terminated from the program and I will be charged a $25.00 administrative fee. A VOIDED CHECK (NOT DEPOSIT SLIP) MUST BE ATTACHED. Important Note: Automatic debit payments will begin on the next period after receipt of this form. Name(s): Home Phone: Unit Address: Alt Phone: Mailing Address (if different): Street Address City State Zip
Financial Institution Name. Bank Phone Number: Bank Address: ABA Routing #: Bank Account #: Checking Account Savings Account.
Financial Institution Name. Address: City: Province: Postal Code:
Examples of Financial Institution Name in a sentence
Financial Institution Name Financial Institution Address Contact Name Telephone City State Zip Account Type Business Checking Savings Personal Checking General Ledger Routing Number Account Number (include all leading 0's) Authorized Signature on Account X Printed Name Title Date This ACH Authorization must be accompanied by a printed Voided Check or a letter from your financial institution stating the Customer's name, Routing Number, and Account Number.
Financial Institution Name: Enter your Financial Institution’s name (this is the name of the bank or qualifying depository • that will receive the funds).
Contact your bank if you are not sure what number to put in this field.3. Financial Institution Name, Address, City, State, Zip Code.
Financial Institution Name Enter the name of the bank, savings and loan or credit union where your account is held, i.e.: Bank-One.
Financial Institution Information: Account Type: ⬜ Checking ⬜ Savings Financial Institution Name If account type is not selected, checking will be used.
More Definitions of Financial Institution Name
Financial Institution Name. Address: City: State: Zip: Phone #:( ) Checking or Savings Acct. Routing #: Account #: FINANCIAL INSTITUTION DEBIT AUTHORIZATION I authorize a ONE TIME ONLY Double Debit of my account for TWICE the amount written on line # 5 above: Client Initials X There IS / IS NOT an automatic debit on my current mortgage loan. (Refer to #11 on back) Client Initials X NOTE: VOIDED CHECK OR CODED DEPOSIT SLIP MUST BE ATTACHED! CALL CREDIT UNIONS TO VERIFY DRAFTABILITY Client and Administrator agree as follows: Upon receipt and acceptance of this application by Administrator, Client will receive an acknowledgment letter confirming that this application has been accepted and Client’s account has been established. This document (front and back) shall then become a binding agreement. Administrator will provide the Client with the following services: A withdrawal schedule showing the dates the funds are to be transferred from the Client’s financial institution account and automatic payment of the Client’s mortgage to the lender named above. IMPORTANT NOTICE TO CLIENT: IF YOU HAVE NOT RECEIVED FINAL VERIFICATION THAT YOUR ACCOUNT HAS BEEN ESTABLISHED FROM ADMINISTRATOR WITHIN 30 DAYS OF THE DATE THIS APPLICATION WAS MADE, PLEASE DO THE FOLLOWING: 1) CONTINUE TO MAKE YOUR MORTGAGE PAYMENTS. 2) CALL ADMINISTRATOR AT (000) 000-0000 AFTER YOU HAVE CHECKED WITH YOUR LOCAL PLAN REPRESENTATIVE. RIGHT TO CANCEL: You as the client have a right to cancel this transaction, without cost, within three (3) business days from the date you receive this notice of your right to cancel. The date is stated below and acknowledged by Client’s signature. In the event of cancellation, any refund due Client for any enrollment fee or other charges paid to the Plan Representative shall be the sole responsibility of the Plan Representative and the Administrator shall not be responsible therefore. AUTHORIZATION FOR AUTOMATIC TRANSFER OF FUNDS I (we) hereby authorize the transfer of funds between the accounts held in the institutions listed above and at the frequency shown above, for the purpose of making payments in my (our) behalf. I (we) authorize the institutions named above to accept the debit or credit entries and to debit or credit the accounts shown. I (we) further authorize the release of mortgage information to Administrator for the purpose of status, maintenance, and ongoing service of my (our) loan referenced above. I (we) agree that the rights of the institutions named above in respect to ea...
Financial Institution Name. Branch: City: State: ZIP: Nine Digit Routing Number: Account Number: This authorization is to remain in full force and effect until Xxxxx Springs Utility Department has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Xxxxx Springs Utility Department and Depository a reasonable opportunity to act on it. Name on Utility Bill: Utility Bill Account Number: Utility Bill Account Number: Utility Bill Account Number: Authorized Signature: Date: Authorized Signature: Date: NOTE: All written debit authorization must provide that the receiver may revoke the authorization only by notifying the originator in the manner specified in the authorization.
Financial Institution Name. Checking: or Savings: Checking Account Name: Routing Number: : Account Number: RECURRING DEBITS Payment Start Date: Amount: Variable based on invoice, not to exceed: Number of Payments: monthly until services terminated. This authorization is to remain in full force and effect until Healthcare Management Systems has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Healthcare Management Systems a reasonable opportunity to act. Notice of revocation of authorization should be sent to the address listed below: Accounts Receivable Healthcare Management Systems 0000 Xxxxx Xxxx Napa, CA 94558 Printed Name:
Financial Institution Name. Address: City, State, Zip: Type of account: Routing #: Account #: Company Authorized Signature: Date:
Financial Institution Name. Branch: Address: City: State: Zip: Routing Number: Acct. Number: Type of Account Checking Savings Payment Amount: (varying amount – as determined by billing period) This authorization is to remain in full force and effect until the COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford the COMPANY and FINANCIAL INSTITUTION a reasonable opportunity to act on it. Account Holder: Xxxxxx Account #: Phone Number: ( ) - Address: City: State: Zip: Signature: Date: Please Attach a Voided Check (NOT a Deposit Slip) From the Account to be Debited Please mail completed form to: Xxxxxx Water Corp.
Financial Institution Name. City: State: Transit / Routing #: 🞏 Checking 🞏 Savings Financial Institution Account #: I understand that this authorization will be in effect until I notify my financial institution in writing that I no longer desire this service, allowing it reasonable time to act on my notification. I also understand that if corrections in the debit amount are necessary, it may involve an adjustment (credit or debit) to my account. I have the right to stop payment of a debit entry by notifying my financial institution before the account is charged. If an erroneous debit entry is charged against my account, I have the right to have the amount of the entry credited to my account by my financial institution. I agree to give my financial institution a written notice identifying the entry, stating that it is in error, and requesting credit back to my account. I will provide this written notice within 15 calendar days following the date on which I was sent a statement of my account or a written notice of such entry, or 45 days after posting, whichever occurs first.
Financial Institution Name. Silicon Valley Bank Financial Institution Address: 0000 Xxxxxx Xxxxx City: Santa Xxxxx State: CA Zip: 95054