Affidavit Of Unauthorized Ach Form Page 2
Download a blank fillable Affidavit Of Unauthorized Ach Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Affidavit Of Unauthorized Ach Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Affidavit of Unauthorized ACH
Page 2 of 2
PART 4: Signature – Required
I further state that the debit transaction was not originated with fraudulent intent by me or any person acting in concert with me, and that the
signature below is my own proper signature.
I have read this statement in its entirety and attest that the information provided on this statement is true and correct.
Signature:
Print Name:
Date:
(mm/dd/yyyy)
Please mail or fax this completed, signed form and any additional information requested above to:
The Bancorp Bank / The Bancorp HSA
409 Silverside Road, Suite 105
Wilmington, DE 19809
Fax: 302.791.5680
11/2014
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business