Fillable Electronic Funds Transfer Authorization (City of Oakland)

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Electronic Funds Transfer Authorization (City of Oakland)

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Electronic Funds Transfer Authorization
This form is an authorization agreement for Automated Clearing House pre-authorized
corporate payments. The
undersigned hereby authorizes Accion Opportunity Fund to submit payments via the Automated Clearing House to
the account at the Depository Financial Institution named below.
Company Name:
Bank Name:
Name on Bank Account:
Bank Address:
Bank Routing Number
(for ACH):
Bank Account Number:
This authorization will remain in effect until written notification of termination has been given by the vendor
and
that notification has been received by Accion Opportunity Fund.
Tax ID:
Authorized
Signature:
Name Printed: Date:
Title: Phone #:
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Electronic Funds Transfer Authorization (City of Oakland)

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Completed 20 November 2021

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