ACH Client Authorization Form

1

Select Property Address

2126 Nashboro Blvd

906 Iris

Olympic Court

239 Flat Ridge Road

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 Admin Fee

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 will be on or around the 1st of each month and varied by weekends and holidays. You agree to go by our monthly schedule which will be sent to you by email showing upcoming dates, and agree to notify us ahead of time if you need to change a payment date.

I Agree

Does not apply to me at this time

14

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 fee from White House Realtors.

YESNO

15

Signature* This field is required.