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  • ACH Authorization

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    Thomas Keeler
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    This document is an authorization form allowing Berkshire Notary Services to initiate automatic payments from a customer's checking or savings account. The customer provides their financial institution information and signatures to permit Berkshire Notary Services to debit set amounts or maximum amounts directly from the designated bank account. The authorization will remain in effect until the customer cancels it in writing.

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    Automatic Clearing House Authorization form

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    This document is an authorization form allowing Berkshire Notary Services to initiate automatic payments from a customer's checking or savings account. The customer provides their financial institution information and signatures to permit Berkshire Notary Services to debit set amounts or maximum amounts directly from the designated bank account. The authorization will remain in effect until the customer cancels it in writing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    69 views1 page

    ACH Authorization

    Uploaded by

    Thomas Keeler
    This document is an authorization form allowing Berkshire Notary Services to initiate automatic payments from a customer's checking or savings account. The customer provides their financial institution information and signatures to permit Berkshire Notary Services to debit set amounts or maximum amounts directly from the designated bank account. The authorization will remain in effect until the customer cancels it in writing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    From the Office of 370 Fort Hill Avenue

    Thomas A. Keeler Pittsfield, MA 01201


    Berkshire Notary Services (413) 358.5104

    ACH Authorization Form

    I (we) hereby authorize Berkshire Notary Services (the company) to initiate entries to my (our)
    checking/savings accounts at the financial institution listed below (the Financial Institution), and, if
    necessary, initiate adjustments for any transactions credited/debited in error. This authority will remain
    in effect until Berkshire Notary Services is notified by me (us) in writing to cancel it in such time as to
    afford Berkshire Notary Services and the financial institution a reasonable opportunity to act on it.

    ______________________________________________

    (Name of Financial Institution)

    ______________________________________________

    (Address of Financial Institution)

    _________________________________ ________/________/________

    (Signature) (Date)

    _________________________________

    (Name – Please Print)

    ______________________________________________

    (Address – Please Print)

    Set amount $________ or Maximum Amount $________

    Financial Institution Routing Number: ________________________________

    Checking/Savings Account Number: ______________________________

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