Transcription of AUTHORIZATION AGREEMENT FOR AUTOMATIC DEBITS …
1 March 23, 2017 AUTHORIZATION AGREEMENT FOR AUTOMATIC DEBITS (ACH DEBITS )COMPANY NAME_____I (we) hereby authorize McClelland and Hine Inc., hereinafter called MHI, to initiate authorized debit entries and to initiate, if necessary, authorized credit entries and adjustments for debit entries in error to my (our) checking account indicated below at the depository named below, hereafter called DEPOSITORY, to debit and/or credit the same to such BRANCH _____CITY_____ STATE_____ ZIP _____TRANSIT/ABA ACCOUNT NO. _____This authority is to remain in full force and effect for the Depository information above only until MHI has received written notification from me (or either of us) of its termination in such time and in such manner asto afford MHI and Depository a reasonable opportunity to act on AUTHORIZATION AGREEMENT is to establish my (our) Depository information above with MHI.
2 At no time does MHI have AUTHORIZATION to debit and/or credit my (our) checking account without my (our) AUTHORIZATION to do so. AUTHORIZED SIGNER _____ FEDERAL EIN# _____(PLEASE PRINT)SIGNED X _____ DATE _____2200 Thousand Oaks #100, San Antonio, TX 78232(P) 210-366-2500 (Wats) 800-333-2017 (F)
