Authorization Agreement for Direct Payment (ACH Debit)
(Contract Buyer)
I/we hereby authorize SECURED ESCROW SERVICES, LLC., hereinafter called COMPANY, to initiate debit entries to my/our
Checking Account
Savings Account
indicated below at the depository financial institution named below, hereafter called 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.
Depository Name:
Branch:
City:
State:
Zip:
Account Number:
Bank Routing Number (9 digits):
Specify Amount to be Withdrawn:
This authorization is to remain in full force and effect until COMPANY has received written notification from me/us of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.
Customer Names:
Property Address:
Please make my deduction on the:
1st
5th
10th
15th
20th
25th
Contract Number:
Last 4 digits of SSN/TIN (for verification):