TRF Rentals ACH Direct Deposit/Debit Authorization

Consumer Authorization for Direct Funds Transfer Via ACH

(ACH Debits and Credits)
Direct Payment via ACH is the transfer of funds from an account for the purpose of making a payment.
Check one:*

Begin PaymentChange InformationEnd Payment
I (we) hereby authorize Thief River Falls Rentals LLC (“COMPANY”) to electronically debit and/or credit my (our) account (and, if necessary, to electronically credit and/or debit my (our) account to correct erroneous debits and/or credits) as follows:
Account Type*

Personal Checking AccountPersonal Savings AccountBusiness Checking AccountBusiness Savings Account
at the depository financial institution named below (“DEPOSITORY”). I (we) agree to be bound by the Nacha Operating Rules and agree that ACH transactions I (we) authorize comply with all applicable law.
Depository Name / Bank Name:*
Routing Number:*
XXXXXXXXX 9 digits
Account Number*
Confirm Account Number*
Name(s) on the Account:*
Amount authorized to debit(s) and/or credit(s) or method of determining amount of debit(s) and/or credit(s): Amount owed each month for rent, and/or other monies owed for housing, to debit and/or credit on the 1st available day of each month, in the amount of:
Once per Month
I (we) understand that this authorization will remain in full force and effect until I (we) notify Thief River Falls Rentals, LLC in writing, that I (we) wish to revoke this authorization. I (we) understand that Thief River Falls Rentals, LLC requires at least five (5) business days prior notice to cancel this authorization.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Signature*

Clear
Should be Empty:

Consumer Authorization for Direct Funds Transfer Via ACH

Direct Payment via ACH is the transfer of funds from an account for the purpose of making a payment.