Copyright Envision Corporation. 2002. All rights reserved.

Protected by the copyright laws of the United States & Canada and by nternational treaties. ! S
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September 4, 2014
Contact $a0e
Address
Address2
City+ State1Province
2ip1Postal Code
OBJECT: AUTHORIZATION TO DEBIT ACCOUNT
%ear 3C($!AC! $A.E4+
!his letter is to ac5nowledge that 3C(.PA$'1$%-%UA"4 is hereby a6thori7ed to debit o6r acco6nt no.
3ACC(U$! $U.*E&4 in the a0o6nt of 3A.(U$!4 for pay0ent of 3$A!U&E (, %E*!4. Please
withdraw the f6nds fro0 the following ban5 acco6nt8
*an58 3*A$9 $A.E A$% A%%&ESS4
*an5 !ransit $o8 3*A$9 !&A$S! $(4
Acco6nt $o8 3ACC(U$! $U.*E&4
*an5 !el. $o. 3*A$9 !E"EP)($E $(4
*an5 Contact 3$A.E (, *A$9 C($!AC! & !!"E4
!his shall be yo6r good and s6fficient a6thority for doing so. /e enclose a blan5 chec5 fro0 the acco6nt
0ar5ed :-(%:.
3$(!E8 , .(&E !)A$ ($E S#$A!U&E S &E;U&E% ($ ACC(U$!+ .A9E SU&E *(!) *A$9
S#$$# (,,CE&S S#$ "E!!E&4
Sincerely+
'o6r na0e
'o6r title
<=00> ?2@ABCDE
yo6re0ailFyo6rco0pany.co0
Company Name
Street+ City+ State1Province+ 2ip1Postal code !el8 <000> 000A0000 1 ,aG8 <000> 000A0000
www.yo6rwebsite.co0

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