AUTOMATIC PAYMENT AUTHORIZATION

 

GFK CONDOMINIUM MANAGEMENT

 

HOMEOWNER: 

 

 

 

100 West Harrison Street

Suite 530

Seattle, WA  98119

 

Name: ________________________

Address:_______________________

              _______________________

 

 

Association Name:

                                                                                               

Homeowner Instructions:

1.     

Date of Initial Draw:

 

 

___________________
 
Complete the Homeowner required information section above.

2.      Specify the bank and account from which payment will be withdrawn.

3.      Specify the first date of draw.

4.      Sign the bottom of the form.

5.      Attach a voided check to the form.

6.      Retain a copy of this form. 

7.      Return the original to your management company.

 

Complete for DIRECT DEPOSIT

I would like my homeowner association dues withdrawn from the following bank account:

 

£ Checking  Account                                                             £ Savings Account

      Bank Name ___________________________                      Bank Name_________________________

 (Attach only a voided check, bank letter or specification sheet,              (Attach only a voided check, bank letter or specification sheet,

Deposit tickets are not accepted.)                                                                 Deposit tickets are not accepted.)

 

Amount of Draw   $  ___________________         Date of Initial Draw: ___________________

 

£ Monthly (Will be drawn on the 5th or earliest following banking day)               

£ One-Time Only (Please Specify Date)  ________________________ (Please allow 2 business days for transaction to clear bank)

 

Please DO NOT write in box below.

Management Use Only:

 

From:

Routing No.________________________________   Account No.____________________________

To:

Routing No.________________________________   Account No.____________________________

 

£ QB          £ FB          £ MT

 

I hereby authorize GFK Condominium Management, (hereinafter COMPANY), to withdraw any amount owed by me by initiating debit entries to my account at the financial institution (hereinafter BANK) indicated above. Further, I authorize BANK to accept and to debit my account for entries indicated by COMPANY.  In the event that COMPANY withdraws funds erroneously from my account, I authorize COMPANY to credit my account for an amount not to exceed the original amount of the erroneous debit.

                This authorization is to remain in full force and effect until COMPANY and BANK have received written notice from me of its termination in such time and in such manner as to afford COMPANY and BANK a reasonable opportunity to act on it.

 

Homeowner Signature:__________________________________________              Date:____/____/____ 

 

Return this original form to your management company