Automatic Withdrawal Authorization
I hereby authorize my HOA management company Integral HOA Solutions hereinafter called “Company”, to initiate debit entries and, if necessary, debit correction and adjustments to my account at the financial institution listed below. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law.
Bank Name / Financial Institution
*
Bank Routing Number
*
Bank Account Number Include all leading 0's
*
Bank Account Type:
*
Checking:
Savings:
Payment Date Options
*
1st of the Month:
15th of the Month:
Termination:
The authority is to remain in full force and effective until “Company” has received written notification from the recipient of its termination in such a time and manner as to afford "Company” a reasonable time to act upon it.
Fees:
The “Company” will charge $35.00 to the homeowners account for each ACH return due to Non-Sufficient-Funds (NSF).
HOA Association Name
*
Address of property in the HOA Association
*
Phone Number
*
E-Mail
*
example@example.com
Signature
*
Printed Name
*
Date
*
/
Month
/
Day
Year
Date
This
form
can be submitted using any of the following options:
On
-
line:
www.integralhoa.com
and clicking on ACH form
E-
mail:
Send a copy or photo of this form to
support@integralhoa.com
USPS: Integral HOA Solutions, PO BOX 277, Elburn IL 60119
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