Bank Transfer Authorization

Bank Transfer
Instructions: Please complete this form and return it to us. We will call you to acknowledge receipt of this authorization and we will speak with you personally to obtain your bank Routing Number and Account Number

Note: This form is not directly linked to a bank account or payment processing system. It merely provides information to our office for secure manual entry through our Intuit Payment Solutions account.
Property information
Name of Charles River associate who directed you to this form*

First Name Last Name
Location of property*
Authorization
I authorize Charles River Properties LLC to electronically debit my bank account according to the terms outlined below. I acknowledge that electronic debits against my account must comply with United States law. By submitting this form, I attest that I am an authorized signer for this account.
Terms of billing
Customer Name*

First Name Last Name
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area Code Phone Number
This form authorizes the one-time, immediate transfer of the dollar amount entered here.*
Customer Bank Account information
Account type*

CheckingSavings
Is this a Consumer account or a Business account?*

ConsumerBusiness
To protect your personal information, we will not ask you to provide your bank Routing Number and Account Nimber on this form. You can provide that information to us when we speak with you to confirm your auhorization to proceed. Note that upon completion of the transaction, you will receive a receipt from Intuit Payment Solutions.

Charles River Properties LLC

280 Moody Street

Waltham, MA 02453

781-703-1960
Should be Empty:

Bank Transfer

Property information

Authorization

Terms of billing

Customer Bank Account information