Electronic Funds Transfer Authorization Form
1. I the undersigned, certify that I am a signer on the account listed below with the authority to grant this authorization.
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I Agree
2. I the undersigned, certify that FoodPRO Corporation or any agentsof FoodPRO Corporation is authorized to debit the account referenced below viadraft (ACH) or other Electronic Funds Transfers (EFT).
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I Agree
3. I the undersigned, certify that the bank referenced below is hereby requested,authorized and directed to honor and treat as authorized, checks, drafts or moneys drawn in my name in accordance with this authorization.
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I Agree
4. I the undersigned, certify that in the event any such draft or EFT is returned unpaid, I agree to have the account referenced below debited electronically or otherwise drafted for an item fee of $39.00, plus any applicable taxes.
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I Agree
5. I the undersigned, authorize FoodPRO Corporation to initiate recurring EFT drafts on the account to pay outstanding balances and obligations as they become due.
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I Authorize
6. I the undersigned, certify that this authorization shall remain in effect and the authority herein given to FoodPRO Corporation shall remain irrevocable until FoodPRO Corporation receives written notice of revocation of such authority. Revocation shall not affect any action taken prior to receipt of such notice.
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I Agree
Customer | Company Name
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Account Name
Account Name
Business Contact's email
example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
BANK NAME
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Bank Routing Number
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Bank Account Number
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Authorizing Signature
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Authorizers Name
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First Name
Last Name
Authorizer Title
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Submit
Should be Empty: