ACH Form: Direct Deposit for Owners/Vendors

Direct Deposit for Owners/Vendors
Check One of the Following:
Company/Individual Name
Telephone #
Format: (000) 000-0000.
E-mail Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank Name
Routing Number (9 digits)
Checking Account #
*Please attach a voided check to top of check sample above
**Please make sure a voided check from the account is given and not a deposit slip
I hereby authorize PayLease LLC to deposit any amounts owed to me, as instructed by the Management Company listed above, by initiating credit entries to my account at the financial institution indicated on this form. In the event that PayLease deposits funds erroneously into my account, I authorize PayLease to debit my account for an amount not to exceed the original amount of the erroneous credit.
Owner/Vendor - Print Name:
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Thank you,

All County Property Management North Metro

700 Abbey Ct., Alpharetta, GA 30004

O: 770-663-4260 | F:770-663-4146
Should be Empty: