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  • ACH Form

    17235 Mount Vernon Street, Southfield MI 48075
  • Authorization Agreement for ACH Debit The undersigned hereby authorizes the First State Bank (FSB) to initiate electronic fund debit entries to my (our) account indicated below at the depository financial institution named below, and to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply under the rules of the National Automated Clearing House Association (NACHA) and with the provisions of U.S. law.
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