PREAUTHORIZED BILL PAYMENTS
Preauthorized bill payment is a debit application. Companies with billing operations may participate in the ACH through electronic transfer (direct debit) of bill payment entries. Through standing authorizations, the consumer grants the company authority to initiate periodic charges to his or her account (s) as bills become due.
The
receive the many benefits of this service, you will need to sign an
authorization for us to automatically debit your personal checking or savings
account. We will transmit your
debit information to the Company’s bank for processing. The information will then be transmitted to your bank or
savings institution for withdrawal from your account.
Because virtually all financial institutions participate in the direct
debit program, there should be no need to alter your current banking
arrangement.
Consider the following benefits:
· Convenience of not having to write checks.
·
Elimination of postage expense and the
risk of late payments.
·
Avoidance of late interest charges through
prompt, timely payments.
·
Establishment of excellent payment and
credit records.
To help us determine your interest
in the direct debit service, please check one of the following spaces and return
this form. If the service is
implemented, we will send you additional information.
______
I would participate in direct debit.
______
I’m interested, but would like more information.
______
I’m not interested in direct debit at this time.
AUTHORIZATION
AGREEMENT FOR PREARRANGED PAYMENT (ACH DEBITS)
Your name:
_______________________________________ Property Address:
______________________________________
I (we) hereby authorize
_____________________________ to initiate charges to the checking ( ) savings (
) account in the amount specified below, and the depository named below is
authorized to debit that account. If
the amount varies, the company will send written notice of the amount and the
scheduled date of transfer at least ten calendar days before the scheduled
transfer date.
Depository Name:
__________________________________ Branch:
_______________________________________________
City: ___________________________ State:
______________ Zip Code: ________________________
Bank Transit/ABA
__________________________________ Account Number
______________________________________
Amount
Range of Amounts
Exceeds
Transfer Date
$__________________ $_____________-____________ $__________
_____________________
This authority is to remain in effect
until the depository has received written notice of termination and has been
provided opportunity to take action. The
depository customer has the right to stop payment of debit entry by notifying
the depository prior to charging the account.
If the organization initiates an incorrect debit entry to the
customer’s account, the customer has the right to ask the depository to credit
the amount from that entry to the
account. To obtain proper credit to
the account the customer shall have fulfilled the following conditions: Notify
the depository in writing of the incorrect entry within fifteen calendar days
following the date the customer received the statement of account or a written
notification of that entry or 60 calendar days after posting, whichever comes
first.
Name
______________________________________ Property Address
_______________________________________________
Date ______________________ Signed
_______________________________ Signed ____________________________________