AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS)



I (we) hereby authorize Selectel,Inc. and/or National Coverage hereinafter called COMPANY to initiate debit entries into my (our) business checking account indicated below at the depository financial institution named below, hereafter called DEPOSITORY, and to debit the same to such account. I (we) acknowledge that the origination of the ACH transactions to my (our) account must comply with the provisions of U.S. law.


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.


NOTE: WRITTEN DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION.

Procedure – For ACH Collections, Selectel shall debit via ACH the appropriate Business Checking Account on Tuesday’s and Friday’s of each week, or as needed based on product sales or type of product offered, for the prior period’s activity for the net amount due (i.e. gross sales less margin).

ATTACH VOIDED (Imprinted) BUSINESS CHECK HERE

FAX TO 888-306-1066 OR E-MAIL THIS FORM TO Michael@mynationalcoverage.com

If there is a change in banking information, please contact us.


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