Ach/direct Deposit Payment Authorization Form - Ohio River Properties, Llc

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ACH/DIRECT DEPOSIT PAYMENT AUTHORIZATION FORM
BILLING INFORMATION:
Name as it appears on Bank Account __________________________________________________
Address as it appears on Bank Account ________________________________________________
________________________________________________________________________________
Bank Name ______________________________________________________________________
Routing # ________________________________________________________________________
Account # ________________________________________________________________________
ACH/DIRECT DEPOSIT AUTHORIZATION
○Custom: _______________________
Select One
○Weekly
○Bi-Weekly ○Monthly
I certify that I am an authorized owner of the above referenced account and therefore authorize Ohio
River Properties, LLC or their authorized transaction agent(s) to charge my bank account indicated
above for the rent payment in the amount of $_____________ on the schedule indicated above starting
on ____________________.
Signature _____________________________________________
Date _________________
Print Name/Title ____________________________________________________________________
Important Notice: In order to cancel this recurring ACH/direct debit transaction, a notice of at least 10
business days prior to the next payment period is required

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