Payment Forms | Bridgeport Rooms

DEBIT AUTHORIZATION

I (we) hereby authorize, JDC LANDSCAPING LLC hereinafter called COMPANY, to initiate debit entries for from my (our) account indicated below and the financial institution named below, hereinafter called FINANCIAL INSTITUTION, to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.

First Name

Last Name

Phone

Bank Name

Branch

Bank Address

Enter a number

Type of Account

Checking

Savings

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This authority 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 manner as to afford COMPANY and FINANCIAL INSTITUTION a reasonable opportunity to act on it.

Check the box if you agree to the following: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on t application

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