Authorization Agreement For Preauthorized Payments printable pdf download

Authorization Agreement For Preauthorized Payments

AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS (ACH DEBITS)

NEXT GENERATION MINISTRIES * ID #

I (we) hereby authorize NEXT GENERATION MINISTRIES, hereinafter called COMPANY, to initiate

debit entries in the amount of $__________ to my (our)

Checking

Savings account (select one)

indicated below, and the depository named below, hereinafter called DEPOSITORY, to debit the same to such

account. This is to occur

Monthly

Semimonthly (select one) on ___________ day of the month.

DEPOSITORY

NAME _____________________________________________ BRANCH ____________________________

CITY _________________________________________ STATE ______________ ZIP_________________

TRANSIT/ABA NO. _____________________________ ACCOUNT NO. ___________________________

This authority 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.

NAME(S)___________________________________________ _____________________________________

(

Printed & Signature)

NAME(S) ________________________________________________________________________________

(

Printed & Signature)

Please include all signatures on the account (if not enough lines please print and sign on back of form)

Please be aware that your bank statement will show a debit ACH of the amount stated above from

either NEXT GENERATION MINISTRIES or WHITNEY NATIONAL BANK.

Please attach a VOIDED check here

NEXT GENERATION

5000 West Esplanade Avenue, Suite 112 * Metairie, Louisiana 70006 * 504-885-0980

Authorization Agreement For Preauthorized Payments