Valley Maintenance Corporation Authorization Agreement for Direct Deposits

Valley Maintenance Corporation

Authorization Agreement for Direct Deposits (ACH Debits)
I (we) hereby authorize Valley Maintenance Corporation (and/or its duly authorized Manager), to initiate Debit entries to my (our) Checking Account indicated below at the depository financial institution named below, hereinafter called the DEPOSITORY, and to Debit the amount of the regular water billing to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.
DEPOSITORY NAME*
BRANCH*
CITY*
STATE*
ZIP*
ROUTING NUMBER*
BANK ACCOUNT*
* The routing number and bank account information can be found on a check for the account as shown on the picture below. If you want to insure that the above information is correctly entered, you may attach a voided check or a cancelled check to Valley Maintenance Corporation from a previous payment.
This authorization is to remain in full force and effect until Valley Maintenance Corporation has received written and signed notification from me (or either of us) of its termination in such time and in such manner as to afford Valley Maintenance Corporation and the DEPOSITORY a reasonable opportunity to act on it.
NAME(S)*
ACCOUNT #*
Service Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CUSTOMER PHONE*
DATE*

MonthDayYear
Date
Name*

First NameLast Name
SIGNATURE*

Clear
Note: All written Debit authorizations should provide that the receiver may revoke the authorization only by notifying the originator in the manner specified in the authorization.
Should be Empty: