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Direct Debit Authorization Form

Save time and postage every month.

Complete this Direct Debit Authorization Form, sign it, include a picture of a voided check from the account you wish the Bank to Debit and Submit it to us.

Beginning with the date designated by you, your payment will be automatically deducted from your Checking or Savings account on your regular payment due date.

Bank Information

Your Information

Clear Signature

Note: It takes between 5-7 business days to set up your Direct Debit request. Please allow this to reflect in your start date.