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ACH Debit Form
Authorization Agreement For Direct Withdrawals (ACH Debits)
This authorization is to remain in full force and effect until 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
I (we) authorize Ramko Distributors, Inc. hereinafter called COMPANY, to initiate debit entries and to initiate, if necessary, credit entries and adjustments for any credit entries in error to my/our account (select one) at the depository financial institution, hereinafter called DEPOSITORY, and to credit the same to such account.
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Checking
Savings
NAME ON CHECK:
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Company or Person Name At The Top Of Your Check
ADDRESS ON CHECK:
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Street Address
City
State / Province / Region
Postal / Zip Code
Phone Number:
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9 DIGIT ROUTING NUMBER:
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This Field Is Encrypted & Secure
ACCOUNT NUMBER:
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This Field Is Encrypted & Secure
FOR THE CALENDAR YEAR OF:
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Ship To Address:
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Street Address
City
State / Province / Region
Postal / Zip Code
PRINTED NAME(S):
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TODAY'S DATE:
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MM
/
DD
/
YYYY
PLEASE UPLOAD A COPY OF A VOIDED CHECK
You Can Also Fax A Copy To 419-470-1801
Or Email A Copy To info@ramkodistributing.com
Signature
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Clear
