PRE-AUTHORIZED PAYMENT, SPECIFIC AMOUNT

. Dear [CONTACT NAME],

This letter is to acknowledge that [COMPANY/INDIVIDUAL] is hereby authorized to withdraw the amount of [AMOUNT OF PERIODIC DEBIT] on a [PERIOD OF PAYMENT] basis on the [BILLING DATE] of each month, until we decide to cancel your services in respect to the terms and conditions we both agreed on. Please withdraw the funds from the following bank account:


Bank: [BANK NAME AND ADDRESS]
Bank Transit No: [BANK TRANSIT NO]
Account No: [ACCOUNT NUMBER]
Bank Tel. No. [BANK TELEPHONE NO]
Bank Contact [NAME OF BANK CONTACT & TITLE]


This shall be your good and sufficient authority for doing so. We enclose a blank check from the account marked "VOID".


[NOTE: IF MORE THAN ONE SIGNATURE IS REQUIRED FOR THIS ACCOUNT, MAKE SURE BOTH BANK SIGNING OFFICERS SIGN LETTER]

Sincerely,


Your name
Your title
(800) 123-4567
youremail@yourcompany.com


Now, Download your favorite business document template for FREE!
PRE-AUTHORIZED PAYMENT, SPECIFIC AMOUNT