AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS (ACH CREDITS)

 

 

Carrier                                                                                          Carrier

Name_______________________________________     ID Number_____________________________________

 

The (Carrier Name)________________________________________________________________________________

hereby authorizes the Alabama Wireless 9-1-1 Board, hereinafter called COMPANY, to initiate credit entries to its

ochecking account, osavings account (select one) indicated below at the depository financial institution named

below, hereinafter called DEPOSITORY, and to credit the same to such account. 

 

The (Carrier Name)________________________________________________________________________________

acknowledges that the origination of ACH transactions to its account must comply with the provisions of U.S. law.

 

Depository

Name_______________________________________     Branch (If applicable)______________________________

 

City________________________________________      State_____________________Zip__________________

 

Routing                                                                                         Account

Number_____________________________________      Number_______________________________________

 

This authorization is to remain in force and effect until COMPANY has received written notification from the authorized individual named below of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

 

Authorized Signer____________________________________________________________________     

                                                                               (Please Print)

 

Signature________________________________________   Date______________________________                                                                               

NOTE:  ALL WRITTEN CREDIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE  AUTHORIZATION.