AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS (ACH CREDITS)
I hereby authorize Saint Martin's University, to initiate credit entries to my:
☐
Checking Account /
☐
Savings Account (select one) indicated below at the depository (bank) financial
institution named below, hereafter called DEPOSITORY, and to credit the same to such account. I
acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S.
Name__________________________________________
Branch__________________________________
City___________________________________________
Number________________________________________
Number________________________________
This authorization is to remain in full force and effect until Saint Martin’s University has received written
notification from me of its termination in such time and in such manner as to afford Saint Martin’s and
DEPOSITORY a reasonable opportunity to act on it.
Name(s)__________________________________________
ID Number____________________________
Date_________________________
Signature________________________________________________
NOTE: WRITTEN CREDIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY
REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER
SPECIFIED IN THE AUTHORIZATION.
RETURN FORM TO ACCOUNTS PAYABLE, FINANCE OFFICE
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