Silverton II HOA

ACH Form

To have your HOA assessments automatically deducted.

Planned Development Services, Inc.

AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS
(ACH DEBITS)


I (we) hereby authorize Planned Development Services, Inc., hereinafter called COMPANY, to initiate debit entries to my (our) Checking Account indicated below at the depository financial institution named below, hereinafter called DEPOSITORY, and to debit the same to such account for the purpose of collecting assessments for my community association. I understand that this debit will occur on or about the 5th of each month in which assessment payments are due. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.

My Bank Information:
Depository
Name ____________________________________
Branch ________________________________

City ____________________________ State ______________________ Zip ___________________

Routing Number _________________________(9 Digits)Account Number ______________________________


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.


Name(s) _____________________________________

_____________________________________
(Please Print)

Association Name: _______________________________________

Lot # _______________


Property Address __________________________________________________________________


Signature(s) __________________________________

____________________________________


Date _____/_____/_____



Please attach a VOIDED CHECK for the account that will be debited and return to:

Planned Development Services
8765 W Kelton Ln, Bldg A-1, Ste 102
Peoria, AZ 85382