A VOIDED CHECK MUST BE INCLUDED WITH THIS FORM
Any Payee listed above must provide a voided check or bank letter for ACH transfer and a signed ACH Authorization Form.
It is the responsibility of the ATM Operator to verify that all information contained in the exhibits and all other forms submitted to Intelligent eCommerce, Inc (ATMDepot.com), or any modification thereof, are correct and complete. ATMDepot.com and/or its 3rd Party Service Providers has no responsibility to verify any such information and will not be responsible for any claims whatsoever related to any incorrect information submitted to ATMDepot.com. ATM Operator shall notify ATMDepot.com of any disputed item or items. ATMDepot and/or its 3rd Party Service Providers shall not be liable for any amounts which were transmitted in error over twenty-five (25) days prior to the date ATMDepot.com receives notice from ATM Operator, regardless of fault.
I hereby authorize ATMDepot.com and/or its 3rd Party Service Providers to initiate ACH transfers for the following: adjustments, error corrections, chargebacks, daily settlements, maintenance, monthly commissions, and/or debit the account identified herein.