Authorization Agreement for Direct Deposits (ACH Credits)
Payee Name _____________________________ SSN/FEIN#_________________________________
I (we) hereby authorize Metro West Housing Solutions (MWHS,) to initiate credit entries to my (our) ( ) Checking ( ) Savings account (select one) indicated below at the depository financial institution named below, hereinafter called Depository, and to credit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provision of U.S. law.
Depository Name ____________________ Type of Account (Please mark only one)
□ Personal
□ Business
City _______________________ State________ Zip____________________
Routing Number _______________________ Account Number_________________________
This authorization is to remain in full force and effect until MQHS has received written notification from me (or either/any of us) of its termination in such time and in such manner as to afford MWHS and the Depository a reasonable opportunity to act on it.
Name(s) _________________________________________________________________________________________________________________________________
Signed _________________________________________________________________________________________________________________________________
Dated _________________________________________________________________________________________________________________________________
Email Address _________________________________________________________________________________________________________________________________
Note: All written credit authorizations should provide that the receiver may revoke the authorization only by notifying the originator in the manner specified in the authorization.
(Attach copy of check here.)
*ALTERNATIVE FORMATS OF THIS DOCUMENT AVAILABLE UPON REQUEST*
