AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS
Automatic Checking Deductions
 
Unit Owner Name
Acct No or Unit
 
I (we) hereby authorized
hereinafter called the
ASSOCIATION
, to initialize entries to my (our) checking account at the DEPOSITORY INSTITUTION listed below, to debit the same to such account. I understand my participation in this program involves deduction from my account listed below, which can be subject to corrections and/or adjustments as instructed by the
ASSOCIATION
.
Unit Owner's Bank Name
Bank Address
Routing number or ABA number
Account number
DDA
SAV
Amount of monthly dues or
Payment
Frequency
This authorization is to remain in full force and effect until
has received writen notification from me (or either of us) of its termination in such time and in such manner as to afford
& EXECUTIVE NATIONAL BANK a reasonable opportunity to act on it.
_______________________________________________________________________________
Signature of Member
Date
_______________________________________________________________________________
Signature of Member (2nd authorized person)
Date
Attention participants: Whenever possible provide
a copy of a voided check to verify bank information. Return or rejected ACHs are subject to late fees