Belle's & Beau's Childcare Center
AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS (ACH CREDITS)
I hereby authorize Belle's & Beau's Childcare Center, a Series of Kinsey Care LLC, hereinafter called COMPANY, to initiate credit entries to my (select one):
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Checking Account
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as indicated below at the depository financial institution named below, hereafter called DEPOSITORY, and to credit the same to such account, and if necessary, debit entries and adjustments for any credit entries in error. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law.
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Address:
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Street Address
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Routing Number:
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Account Number:
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This authorization is to remain in full force and effect until COMPANY has received written notification from me of its termination in such time and manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act upon it.
Name: (Please Print)
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Signature:
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Date:
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NOTE: Please attach a COPY of a check or a VOIDED Check for Authorization
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