EFT Draft Form

EFT Draft Form

Authorization Agreement
ACH Preauthorized Payments (Debits)

Originating Company/Name: Hutchens Petroleum Corporation

Tax ID Number: 54-0987283

I (we) hereby authorize Hutchens Petroleum Corporation to initiate debit entries or such adjusting entries, either debit or credit which are necessary for corrections, to my (our) Checking or Savings account indicated below and the financial institution named below to credit (or debit) the same to such account.
Type of Account*

CheckingSavings
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Financial Institution Name: *
Transit/Routing Number: *
Account Number: Number*
I understand that this authorization will remain in effect until I notify my financial institution in writing that I no longer desire this service, allowing reasonable time to act on my notification. I also understand that if corrections in the debit amount are necessary, it may involve an adjustment (credit or debit) to my account.

I have the right to stop payment of a debit entry by notifying my financial institution before the account is charged. If an erroneous debit entry is charged against my account, I have the right to have the amount of the entry credited to my account by my financial institution. In order to do this, it must be within 15 calendar days following the date on which I was sent a statement of account or a written notice of such entry, or 45 days after posting, whichever occurs first. I will then give my financial institution a written notice identifying the entry, stating that it is in error and requesting credit back to my account.
Customer #1*

First NameLast Name
Customer #1: Social Security Number*
Customer #1: Signature*

Clear
Date*

MonthDayYear
Date
Customer #2

First NameLast Name
Customer #2: Social Security Number
Customer #2: Signature

Clear
Date

MonthDayYear
Date
Should be Empty: