Electronic Funds Transfer Authorization Form I hereby authorize The Association to initiate automatic re-occurring payment from my bank account as specified below:Association:(Required) Name(Required) First Last Address:(Required) Mailing Address (if other than above): Phone(Required)Email(Required) Your Bank Name: Bank Routing Number:(Required) Your Bank Account #:(Required) Select one:(Required) Savings Checking Amount Due**: Consent(Required) I agree to the Direct Debit policy. Period: One time between the third and the sixth of each month due. I understand this authority is to remain in full force and effect until The Association has received written notification from me of its termination in such time and manner as to afford the depositor a reasonable opportunity to act on it. I maintain the right to stop payment of the debit entry (deduction) by written notification delivered to the Association’s business office fifteen (15) business days or more before this payment is scheduled to be made. ** Any adjustment to the debit amount, in accordance with a change in the assessments, will be made automatically after the Association has provided each owner with a minimum of ten (10) days notice of the change in assessment.Date Month Day Year CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
