AUTHORIZATION AGREEMENT FOR
AUTOMATIC DEBITS (ACH DEBITS)
I
authorize Highlands Cooperative Association, Unified Management Services,
(hereinafter referred to as the Company) to make pre-authorized withdrawals
on the fifth day of each month to Comerica Bank.
If the fifth falls on a weekend the withdrawal will be done the next
business day.
I authorize
the Depository Financial Institution listed above to accept these
withdrawals. I also understand
that adjusting entries may be made to correct any errors in the withdrawals.
It is agreed that these withdrawals and adjustments may be made
electronically and are bound by the rules of the Michigan Automated Clearing
House Association. This
authorization is to remain in effect until I provide a written notice of
termination to the Company.
Fill in the
following information required (please print) and sign where the
signature is needed.
Name:
________________________________________________
Address:
________________________________________________
Lansing, MI 48911
Signature:
______________________________________
Date: _________________
The following
needs to be attached to this form when you return it to the Office:
CHECKING ACCOUNT-a voided check
SAVINGS ACCOUNT-deposit ticket
(must write savings account on deposit
slip)
Office Use Only
Property:
Highlands
Cooperative Association
#550
ID #:
______
Amount:
$__________
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HIGHLANDS POLICIES