ACH Authorization Agreement â- Parents. Authorization Agreement For Direct Deposits (ACH DEBITS). Company Name: Fountain City Wesleyan Church...0 downloads 0 Views 61KB Size
ACH Authorization Agreement - Parents Authorization Agreement For Direct Deposits (ACH DEBITS) Company Name: Fountain City Wesleyan Church DBA Kids Kingdom of Wayne County Company ID Number: 35-1473040 I (we) hereby authorize________________________, hereinafter called COMPANY, to initiate debit entries to my (our)____ Checking Account/____Savings Account (select one) indicated below, hereinafter called DEPOSITORY, and to credit the same to such account. I (we) acknowledge that the origination of ACH transmission to my (our) account must comply with the provision of U.S. law. Depository Name:__________________ Branch__________________ City_____________________________State____ Zip_____________ Routing Number_________________Account Number______________ This authorization is to remain in full force and effect until COMPANY has received notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITARY a reasonable opportunity to act on it.
Name(s)________________________ ID Number_________________ (Please Print) Date____________________ Signature_________________________ Please retain a copy of this authorization for your records NOTE ALL WRITTEN CREDIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION