Authorization for Automatic Payment
I authorize and the financial institution named here to initiate entries to my
checking/savings account. The authority will remain in effect until I notify in writing to
change or cancel it in such time as to afford the financial institution a reasonable opportunity to act on it. I can stop
payment of any entry by notifying my back three (3) days before my account is charged. I can have amount of an
erroneous charge immediately credited to my account up to fifteen (15) days following issuance of my bank statement or
sixty (60) days after posting, whichever occurs first.
I understand that it is my responsibility to give advance notice to of any changes to my
account, closing of my account, or change to a different institution.
I wish to contribute every month to for regular operation