SAES ACH PAYMENT AUTHORIZATION

SAES ACH PAYMENT AUTHORIZATION
School Name
City
State
Email
example@example.com
I hereby authorize the Southwestern Association of Episcopal School, herinafter called "Company," to initiate debit entries to my (our) account indicated below, and the Financial Institution named below, herinafter called Financial Institution, to debit the same account. I acknowledge that the origination of ACH transactions to my account must comply with U.S. Law.
Account Details
Financial Institution Name
Routing Number
Account Number
Confirm Account Number
Accounts Numbers Do Not Match. Please Re-enter Account Number
Type of Account

CheckingSavings
Payment Details
2023-24 Membership Dues & Fees
This authorization is to remain in full force and effect until Company has received written notification from me (or any authorized account signer) of its termination in such time and manner as to afford the Company a reasonable opportunity to act on the request.
Print Individual Name
Date
Signature

Clear
Please verify that you are human*
Should be Empty:

Account Details