TRF Rentals ACH Direct Deposit/Debit Authorization

Consumer Authorization for Direct Payment/Direct Deposit Via ACH

(ACH Debits)
Direct Payment via ACH is the transfer of funds from a consumer account for the purpose of making a payment. This form can also be used to authorize Direct Deposit via ACH for the purposes of receiving a payment.
Name(s) on the Account:*
Depository Name / Bank Name:*
Check one:*

Begin PaymentChange InformationEnd Payment
I (we) hereby authorize Thief River Falls Rentals, LLC ("Company") to electronically debit my (our) account (and, if necessary, to electronically credit my (our) account to correct erroneous debits) or to make deposits into my account as follows, at the depository financial institution named below ("DEPOSITORY"). I (we) agree that ACH transactions I (we) authorize comply with all applicable law.
Account Type*

Personal Checking AccountPersonal Savings AccountBusiness Checking AccountBusiness Savings Account
Routing Number:*
XXXXXXXXX 9 digits
Account Number*
Confirm Account Number*
Amount authorized to debit(s) or method of determining amount of debit(s): Amount of rent owed each month, to debit on the 1st available day of each month, in the amount listed below, or to deposit money into my account at the discretion of Thief River Falls Rentals:
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 Payment/Direct Deposit Via ACH

Direct Payment via ACH is the transfer of funds from a consumer account for the purpose of making a payment. This form can also be used to authorize Direct Deposit via ACH for the purposes of receiving a payment.