AUTHORIZATION AGREEMENT FOR PRE-ARRANGED PAYMENTS
INDIVIDUAL OR COMPANY NAME_____________________________________
I (we) hereby authorize BRIGHT.NET-BRT, to initiate debit entries to my (our) Checking or Savings account indicated below and the depository (bank) named below, herein after called DEPOSITORY, to debit the same to such account.
BRANCH (Optional) ________________________________________________
CITY_____________________________ STATE___________ ZIP___________
ACCOUNT NO. C / S _______________________________________________
This authority is to remain in full force and effect until BRIGHT.NET-BRT has received written notification from me (or either of us) of its termination in such time and in such manner as to afford BRIGHT.NET-BRT and DEPOSITORY a reasonable opportunity to act on it. I (or either of us) has the right to stop payment of a debit entry by notification to DEPOSITORY at such time as to afford DEPOSITORY a reasonable opportunity to act on it prior to charging account. After account has been charged, a customer has the right to have the amount of an erroneous debit immediately credited to his account by DEPOSITORY, provided I (we) send written notice of such debit entry in error to DEPOSITORY within 15 days following issuance of the account statement or 45 days after posting, whichever occurs first.
(On a joint account, both husband and wife must sign)
DATE _____ / _____ / _____
*Please attach a VOIDED deposit ticket for account listed above.