AUTHORIZATION FOR PAYMENT PROCESSING

AUTHORIZATION FOR PAYMENT PROCESSING
By completing this form, you authorize Patrick Bell & Associates LLC d/b/a Bell & Associates Property Management to process your rent payments, including any additional rent amounts such as CAM (Common Area Maintenance), taxes, and property insurance (if applicable under your lease), via ACH/EFT.

Payments will be processed monthly on the second day of each month.

This authorization shall remain in effect until you revoke it in writing by sending an email to patrick@bellandassociatesga.com. Revocation will be considered effective upon confirmation of receipt by Bell & Associates Property Management by return email.
PROPERTY*
NAME AS IT APPEARS ON ACCOUNT*
Address*

ADDRESS AS IT APPEARS ON BANK STATEMENT

Street Address Line 2

CITYSTATE

ZIP
ADDRESS (AS IT APPEARS ON BANK STATEMENT)
ROUTING NUMBER*
ACCOUNT NUMBER*
BANK NAME*
BRANCH
TELEPHONE
SIGNATURE AUTHORIZING ACH TRANSACTIONS*

Powered by Jotform SignClear
PRINTED NAME*
TITLE*
Should be Empty: