ACH Authorization Form


 

Authorization for Direct Deposit via ACH (ACH Credit)

 

I (we) hereby authorize Frantz-Gibson Painting Company LLC (“COMPANY”) to electronically credit my (our) account (and, if necessary, to electronically debit my (our) account to correct erroneous credits) as follows:

Select One:

at the depository financial institution named below (“DEPOSITORY”).  I (we) agree that ACH transactions I (we) authorize comply with all applicable law.

 

Bank Name: 

Routing Number: 

Account Number: 

 

Name(s) on the Account: 

 

I (we) understand that this authorization will remain in full force and effect until I (we) notify COMPANY in writing, by phone or by email] that I (we) wish to revoke this authorization.

 

Name:  

Date:

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: ACH Authorization Form
lock iconUnique Document ID: f91e9f82ec3601d891f90e0af74d7775c0785a4f
Timestamp Audit
March 9, 2020 2:14 pm CDTACH Authorization Form Uploaded by Steve Frantz - steve@frantzgibson.com IP 64.237.74.181