ACH Form

Electronic Funds Transfer Authorization Form
This form is an authorization agreement for Automated Clearing House pre-authorized corporate payments.

The undersigned hereby authorizes Best Line Oil Co to originate debit and or credit entries via the Automated Clearing House to the account indicated below at the Depository Financial Institution named below, to accept debit/credit the amount of such entries to the account.
Bank Name*
Bank Contact Name
Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank Address
Bank Transit ABA Number*
Bank Account Number
This authorization will remain in effect until written notification of termination has been given by the customer and that notification has been received by Best Line Oil Con Inc. in addition, Best Line Oil Co, in it's discretion, may terminate the customer's ability to participate in the Electronisc Funds Transfer system.
Grantee Name as shown on Bank Account*
Grantee Tax ID
Date

MonthDayYear
Date
Customer Signature (Must be signed by Owner. Please send Certificate of Sales Tax if Exempt. Must fill out attached W-9)*

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Electronic Funds Transfer Authorization Form