Ach debit authorization form is a document which you use to authorize a specific company or individual to withdraw money from your account. This form is used when you are not able to make the withdrawal yourself, for example, if you are out of town. The form allows the other party to have access to your account information and make the withdrawal on your behalf. Make sure you complete all the necessary information on the form so that it can be processed correctly. If you have any questions about the form or need help completing it, contact your banking institution for assistance.
| Question | Answer |
|---|---|
| Form Name | Ach Debit Authorization Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | issuance, voided, SANITARY, ABA |
ACH DEBIT AUTHORIZATION FORM
AUTHORIZATION AGREEMENT
COMPANY NAME:
GREENVILLE SANITARY DISTRICT #1
I (we) hereby authorize : GREENVILLE SANITARY DISTRICT #1
_________________________________________________________________________________________
hereinafter called COMPANY, to initiate debit entries to my (our) Checking or Savings account indicated below and the depository named below, hereinafter called DEPOSITORY, to debit the same to such account.
NOTE: The dollar amount showing due on the current Sanitary District utility bill will be drawn from account indicated below on the last business day of each month according to the terms of said bill.
DEPOSITORY NAME & ADDRESS
TRANSIT / ABA NUMBER
CHECKING
SAVINGS
ACCOUNT NUMBER
This authority is to remain in full force and effect until COMPANY and DEPOSITORY 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. I (or either of us) has the right to stop payment of a debit entry by notification to DEPOSITORY at such time as to afford DEPOSITORY a reasonable opportunity to act on it prior to charging account. After account has been charged, I have the right to have the amount of an erroneous debit immediately credited to my account by DEPOSITORY, provided I (we) send written notice of such debit entry in error to DEPOSITORY within 15 days following issuance of the account statement or 45 days after posting, whichever occurs first.
Please attach a voided check for account
verification purposes.
SANITARY DISTRICT ACCT #
DATE
NAME (PLEASE PRINT)
NAME (PLEASE PRINT)
SIGNATURE |
SIGNATURE |