Draft Authorization Form I hereby authorize Handy Sanitary District, hereinafter called the COMPANY, to
initiate debit entries and to initiate, if necessary, credit entries and
adjustments for any debit entry in error to my (our) account indicated below
and the Financial Institution named below, hereinafter called DEPOSITORY, to
debit and/or credit the same to such account. This authority is to remain in
full force and effect until the COMPANY has received written notification from
me (or either of us) of its termination in such time and in such manner as to
afford the COMPANY and DEPOSITORY a reasonable opportunity to act on it.
Customer(s) Name: _____________________________________________
Customer(s) Address: _____________________________________________
Customer(s) Handy Sanitary District Account # ___________________________
Important: Please check one of the following:
_____ Checking
_____ Savings
Bank Acct # to be drafted: __ __ __ __ __ __ __ __ __ __
Bank Name: ____________________
Bank Routing #: __ __ __ __ __ __ __ __ __
Bank Address: ___________________________
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Draft Start Date: __________________ | ___________________________ |
____________________________________________
Customer's Signature |
__________________
Date |
Attach Voided Check Here. |
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