Electronic Funds Transfer Authorization For Bank Account Authorization

Electronic Funds Transfer Authorization For Bank Account Authorization
Check the box beside the statement:
- I(we) hereby authorize Montessori Explorer to initiate debit entries to my (our) Checking or Saving Account indicated below. To properly affect the cancellation of this agreement. I(we) are required to give 10 days written notice.
Credit Union Members: Please contact your Credit Union to verify account and routing numbers for automatic payments.
Email
Your Name
Phone #
Address
Street Address City State / Province / Region ZIP / Postal Code
Bank or Credit Union Name
Bank or Credit Union Address
Street Address City State / Province / Region ZIP / Postal Code
Account Type
- Savings
- Checking
Routing Transit Number
Account Number
Signature
Date
Date Format: MM slash DD slash YYYY

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