Auto-Draft Form

I hereby authorize David Floyd & Associates, Inc., acting on behalf of my Homeowners Association (the “ORGANIZATION”), to initiate recurring ACH debit and/or credit entries to my checking account identified below at the depository financial institution identified below (the “DEPOSITORY”). Such entries shall occur on the 6th calendar day of any month in which regular Homeowners Association dues are payable, whether such dues are payable monthly, quarterly, semi-annually, or annually, in the amount of such regular dues as established by the ORGANIZATION. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law.

Homeowners Association Name

Homeowner Name(s)

Property Address to be Credited

Street Address Line 2

Financial Institution Name

Account Holder Name

Bank Routing Number

must be 9 numbers - no spaces

Bank Account Number

must be 4-17 numbers - no spaces

Email

Phone

Format: (000) 000-0000.

Signature

Draw your signature using your mouse or touchscreen.

This authorization is to remain in full force and effect until ORGANIZATION has received written notification from me of its termination in such time and in such manner as to afford ORGANIZATION and DEPOSITORY a reasonable opportunity to act on it.

If there is an outstanding balance on your account, would you like for a one-time draft to be performed to bring your account current?

NOTE: To initiate ACH drafts for any applicable billing period (monthly, quarterly, semi-annually, or annually), the ORGANIZATION must receive this completed authorization form at least five (5) business days prior to the 6th calendar day of the month in which such payment is scheduled to be drafted. If received later, drafts will begin with the next scheduled draft date for the applicable billing period.

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AUTHORIZATION AGREEMENT FOR AUTOMATIC DRAFT