9663 Santa Monica Blvd. Suite 641 Beverly Hills, CA. 90210Phone: 310-926-6800 | Fax: 310-256-3672
AUTHORIZATION FOR AUTO-WITHDRAWAL VIA ACH (ACH DEBIT)
Direct Deposit via ACH is the deposit of fund to a consumer’s account, for example, payroll, employee expense reimbursement, government benefits, tax and other refunds, annuities, and interest payments.
Borrower hereby authorizes ROLAND PROPERTIES, INC. to electronically debit my (our) account (and if necessary, to electronically correct erroneous transactions) as follows:
SELECT ONE Checking AccountSavings Account
As the depository financial institution named below (“DEPOSITORY”). I (we) agree that ACH transactions I(we) authorize comply with all applicable law.
YOUR NAME
YOUR ACCOUNT NUMBER: (Borrower Account)
YOUR PHONE (CELL) NUMBER
YOUR EMAIL ADDRESS
BANK NAME/DEPOSITORY
ROUTING NUMBER
ACCOUNT NUMBER
NAME(S) ON THE ACCOUNT
AMOUNT YOU WISH TO PAY/DEBIT
TRANSACTION DATE FOR ACH DEBIT(S)
I(we) understand that this authorization will remain in full force and effect until (we) notify ROLAND PROPERTIES, INC. in writing that I(we) wish to revoke this authorization. I(we) understand that ROLAND PROPERTIES, INC. requires at least 15 days prior notice in order to cancel this authorization.
NAME(S) (Please Print)
Date
Signature (Please write your signature in the box below)
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