Get Ach Debit Authorization Form 2003-2024

ACH Debit Authorization Agreement AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS ACH DEBITS Company Name Optimist International Address herein referred to as Company 4494 Lindell Blvd. St* Louis MO 63108 Company ID Number 43-0443279 I we hereby authorize Company to initiate debit entries to my our Checking Account Savings Account select one Please debit my our account for Dues Fees select one or more CRA Adds Life Members Purchases All Charges indicated below at the depository financial institution named below hereinafter called DEPOSITORY and to debit the same to such account. I we acknowledge that the origination of ACH transactions to my our account must comply with the provisions of U*S* law. Depository Name City Branch State Routing Number Zip Account This authorization is to remain in full force and effect until COMPANY has received written notification from me or either of us of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it. Depositor Name Club Signature Date Name Title NOTE ALL WRITTEN DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION* Account holder is required to verify bank account data and attach a voided check here. St* Louis MO 63108 Company ID Number 43-0443279 I we hereby authorize Company to initiate debit entries to my our Checking Account Savings Account select one Please debit my our account for Dues Fees select one or more CRA Adds Life Members Purchases All Charges indicated below at the depository financial institution named below hereinafter called DEPOSITORY and to debit the same to such account. I we acknowledge that the origination of ACH transactions to my our account must comply with the provisions of U*S* law. I we acknowledge that the origination of ACH transactions to my our account must comply with the provisions of U*S* law. Depository Name City Branch State Routing Number Zip Account This authorization is to remain in full force and effect until COMPANY has received written notification from me or either of us of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it. Depository Name City Branch State Routing Number Zip Account This authorization is to remain in full force and effect until COMPANY has received written notification from me or either of us of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it. Depositor Name Club Signature Date Name Title NOTE ALL WRITTEN DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION* Account holder is required to verify bank account data and attach a voided check here. St* Louis MO 63108 Company ID Number 43-0443279 I we hereby authorize Company to initiate debit entries to my our Checking Account Savings Account select one Please debit my our account for Dues Fees select one or more CRA Adds Life Members Purchases All Charges indicated below at the depository financial institution named below hereinafter called DEPOSITORY and to debit the same to such account. I we acknowledge that the origination of ACH transactions to my our account must comply with the provisions of U*S* law. Depository Name City Branch State Routing Number Zip Account This authorization is to remain in full force and effect until COMPANY has received written notification from me or either of us of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it. .