ACH Authorization Form

This ACH Authorization Form for Direct Collections is available for Sacia Real Estate Rentals LLC Customers ONLY!

Our office must receive all authorizations by the 15th of the month prior to first ACH for origination or change. Original form must be received.

Type of authorization:

New Authorization

Change Banking Information

Change Amount

Discontinue ACH

Address of Apartment/House You Live In:(Required)

Street Address Address Line 2 City State ZIP Code

Account Owner Name:(Required)

Account Owner Address:(Required)

Street Address Address Line 2 City State ZIP Code

FINANCIAL INFORMATION

Name of Financial Institution:(Required)

Address of Financial Institution:(Required)

Street Address Address Line 2 City State ZIP Code

Monthly Amount To Deduct:(Required)

Checking or Savings:(Required)

Checking Account

Savings Account

9-digit Financial Institution Routing Number(Required)

Checking/Savings Account Number:(Required)

Please Click Box for Authorization:(Required)

ACH Authorization Approved

I hereby authorize Sacia Real Estate Rentals, LLC to initiate entries to my checking/savings accounts at the financial institution listed above, and if necessary, initiate adjustments for any transactions credited/debited in error. This authority will remain in effect until Sacia Real Estate Rentals, LLC is notified by an authorized individual in writing to cancel it in such time as to afford Sacia Real Estate Rentals, LLC and the financial institution a reasonable opportunity to act on it (15 days). Undersigned represents and warrants that the person executing this release is an authorized signatory on the Account, is authorized to transfer funds on the Account referenced above, and all information regarding the Account and Account Owner is true and correct. NSF fees and rules on lease contract apply. I understand a test transaction in the amount of $0.00 may be administered to verify account information before start date.

Today's Date:(Required)

Signature(Required)

Please PRINT name for signature

Captcha

Mailing Address & Dropbox

Contact Information

This ACH Authorization Form for Direct Collections is available for Sacia Real Estate Rentals LLC Customers ONLY!

FINANCIAL INFORMATION

CONTACT INFORMATION