ACH Authorization


Authorization for Payment

By signing this form, I am authorizing Evan Lemoine CPA LLC to initiate an electronic debit in the amount and frequency indicated from the bank account I designate below. I understand that this Authorization will remain in full force and effect until the transaction is cancelled by me by contacting Evan Lemoine CPA LLC at least 10 days in advance, or the ACH/electronic debit is processed from the designated account. I certify that (1) I am authorized to debit the bank account above and (2) that the ACH/electronic payment I am authorizing complies with all applicable laws.

Frequency

I authorize Evan Lemoine CPA LLC to charge my bank account $ .

If recurring, these charges will end upon notifying Evan Lemoine CPA LLC.  If the payment date above falls on a weekend or holiday, I understand the charge may be made the following business day.

ACCOUNT TYPE Text

 

ACCOUNT HOLDER

ROUTING #

ACCOUNT #  

BILLING ADDRESS

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: ACH Authorization
lock iconUnique Document ID: ab2e886e45d062bb99506211fa4d6bff3966be66
Timestamp Audit
May 17, 2022 10:48 am ESTACH Authorization Uploaded by Evan Lemoine - evan@lemoinecpa.com IP 68.14.90.206