TAMIAMI MASTER ASSOCIATION
16555-A N. CLEVELAND AVE.
NORTH FORT MYERS, FL 33903
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENT
(ACH DEBITS)
Tamiami Master Association, Inc.
52-2374592
I (we) hereby authorize Tamiami Master Association, Inc., herein after called
COMPANY, to initiate debit entries to my (our) Checking Account indicated on the
attached voided check, hereinafter called BANK/DEPOSITORY, and to debit the same
to such account. I (we) acknowledge
that the origination of ACH transactions to my (our) account must comply with
the provisions of U.S. law.
You
must provide a voided check to coincide with information listed below.
The authorization 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 BANK/DEPOSITORY a
reasonable opportunity to act on it.
OWNER NAME(S):___________________________________________________________
TAMIAMI VILLAGE STREET ADDRESS:___________________________________________
PHONE #:_____________________
SIGNATURE: _________________________________________________________
DATE: ___________________
MONTHLY AMOUNT:_________________
NOTE:
ALL WRITTEN DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE
AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE
AUTHORIZATION.
OFFICE USE ONLY:
CONTROL #
EFFECTIVE DATE: