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Ach Agreement
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS)
I (we) hereafter called COMPANY, hereby allow PYE POS INC, to initiate debit entries to my (our) Checking Account, and to debit the same to such account for payment of my account. I (we) understand I (we) will receive a notice if the amount changes. I (we) acknowledge that the origination of AUTHORIZATIONS transactions to my (our) account must comply with the provisions of U.S. law. I (we) acknowledge that the debit will occur on a monthly basis.
Depository Name:
City:
Routing Number:
Account#
This authorization is to remain in full force and effect until the agreed upon contract between COMPANY and Pye POS Inc has been satisfied and Pye POS Inc has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Pye POS Inc a reasonable opportunity to act on it.
Name:
Date
MM slash DD slash YYYY
Company Name
Signature
Voided Check
Accepted file types: jpg, jpeg, png, Max. file size: 5 MB.
NOTE: DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING PYE POS INC IN WRITING.
