Credit Authorization Form – Bryan Foundation |

For Receiving Funds from Bryan Foundation

I authorize you and the financial institution below to initiate electronic entry to my Checking Account or Savings Account (select below). This authority will remain in effect until I have canceled it in writing.

The authorization is to remain in full force and effect until the Company has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Company and Depository a reasonable opportunity to act on it.

Checking or Savings *

Checking
Savings

I realize the day of month/amount may differ & authorize you and the financial institution to initiate electronic entry to my account.

Company Name *

Financial Institution *

Name *

City/State *

Signature *

Account Number *

Today's Date *

Account Number *

Routing & Transit Number *

Disclaimer *

I understand that the above company may initiate a reversal of any entry made under this agreement if an error has been made. I understand that the financial institution at which I have the above account is required to provide to me the procedures for resolving errors on entries made under this agreement. I understand that the company will provide a written notice to me of the error within 24 hours.

Attach Voided Check Here

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Email *