ACH Client Authorization Form

1

Property Address

600 12th Ave #524

121 Highland

600 12th Ave #1110

308 Sloan

128 Larkspur

114 A Emily Lane

2

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

I authorize White House Realtors LLC to electronically debit my my acount as follows:

3

Type of Account

Checking

Savings

4

Frequency of payment(s)

One time Application Fee

One time Security Deposit

One time Deposit and monthly rents going forward

Repeated Monthly rent payments

One time rent payment March

One time Admin Fee

one time pet deposit

5

Name on Account* This field is required.

6

Email Address:* This field is required.

example@example.com

7

Bank Routing Number* This field is required.

8

Account Number* This field is required.

9

Amount of debit(s) or specify range of acceptable dollar amounts authorized:* This field is required.

10

Date(s) of debit* This field is required.Funds should be in your account on the 1st of each month. Rents are usually initiated on the 1st of each month, however these dates can fluctuate if the 1st falls on a weekend or during a holiday.

Date

11

Add explanation of payment if needed:

12

I understand that this authorization will remain in full force and effect until I notify White House Realtors LLC that I wish to revoke this authorization.

YESNO

13

Please note: If authorizing monthly rent payments, all monthly rent payments going forward scheduled for the 1st of each month. If the 1st is on a weekend or banking holiday, it will default to the following business day. You agree to this monthly schedule going forward and will notify us ahead of time if changes are needed to avoid bank returns.

I Agree

Does not apply to me at this time

14

I understand that if I make any payments by credit card, there will be an additional 2.99% fee added to each payment.* This field is required.

I Understand

15

I understand if a payment is rejected for reasons other than an error on our end, you may incur fees from your personal bank, in addition to a $50.00 charge from White House Realtors.

YESNO

16

Signature

Clear