Authorization Agreement For Payments

Authorization Agreement For Payments

ACH Debit for Georgetown Association of Professional Firefighters
I hearby autorize Georgetown Association Professional Firefighters (GAPFF), to initiate debit entries to my Checking or Savings Account indicated below at the depository financial institution, Firefighters First Credit Union (FFFCU), and to debit the same to such account. I acknowledge that the origination of the ACH transactions to my account must comply with the provisions of U.S. law.
If currently affiliated with TSAFF or IAFF. What department currently holds your affiliation?
Please type N/A if not affiliated with another department.
Name*

First NameLast Name
Personal Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Cell Provider
Account Type*
Financial Institution Name:*
Routing Number*
Account Number*
Optional: Benevolent Fund Donation (Monthly Amount)
Please write $0 or N/A if you are not opting to donate.
This authorization is to remiain in full force and effect until COMPANY has received notification from me of its termination in such times and in such manner as to afford GAPFF and FFFCU a reasonable opportunity to act on it. The undersigned Debtor agrees to be bound by the NACHA Operationg Rules, as amended and in effect from time to time.

Per GAPFF bylaws, the amount to be collected is 1.35% of the annual base firefighter salary according to the current M&C contract. This amount is divided by 26 and is debited bi-weekly. I understand that this amount will change when the base salary is adjusted. I also understand that union membership is not required to work at Georgetown Fire Department and can opt-out at any time with written notice to the executive board.
Signature*

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