Direct Debit/credit Ach Authorization Form - Mccormick Armstrong
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1Direct Debit/Credit ACH Authorization Form
Instructions: Complete form, print out, sign, fax to 316-263-4511.
I herby authorize McCormick-Armstrong Co., Inc. and their financial institution, Intrust Bank, to initiate
electronic credit/debit entries to my account listed below according to the information provided.
Financial
Branch:
Institution:
Address:
CSZ:
Routing Number
Account Number
Check one:
Checking
Savings
Other:
Account
Account
CHECK ONE:
This authority is to remain in full force and effect until McCormick-Armstrong has received written
notification of its termination.
This authority is for a one time debit according to the information provided below.
Payment for McCormick-Armstrong invoice(s)
No.
Amount of payment $
No.
Amount of payment $
No.
Amount of payment $
No.
Amount of payment $
Print Name
Authorized Signature
Date
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Parent category: Business