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    EFT Agreement - 220928 - 142941 - 221012 - 182009

    Uploaded by

    Carlos Muñoz
    This document authorizes Love's Family of Companies to automatically debit payments from a customer's bank account. It provides the customer's banking information and notifies that the authorization will remain in effect until the customer provides written notice of cancellation. The customer has the right to stop a payment by notifying their bank before the account is charged. The customer must sign and date the document to allow Love's to debit their account.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    EFT Agreement - 220928 - 142941 - 221012 - 182009

    Uploaded by

    Carlos Muñoz
    133 views2 pages
    This document authorizes Love's Family of Companies to automatically debit payments from a customer's bank account. It provides the customer's banking information and notifies that the authorization will remain in effect until the customer provides written notice of cancellation. The customer has the right to stop a payment by notifying their bank before the account is charged. The customer must sign and date the document to allow Love's to debit their account.

    Original Title

    EFT Agreement_220928_142941_221012_182009

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    This document authorizes Love's Family of Companies to automatically debit payments from a customer's bank account. It provides the customer's banking information and notifies that the authorization will remain in effect until the customer provides written notice of cancellation. The customer has the right to stop a payment by notifying their bank before the account is charged. The customer must sign and date the document to allow Love's to debit their account.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    133 views2 pages

    EFT Agreement - 220928 - 142941 - 221012 - 182009

    Uploaded by

    Carlos Muñoz
    This document authorizes Love's Family of Companies to automatically debit payments from a customer's bank account. It provides the customer's banking information and notifies that the authorization will remain in effect until the customer provides written notice of cancellation. The customer has the right to stop a payment by notifying their bank before the account is charged. The customer must sign and date the document to allow Love's to debit their account.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    AUTHORIZED AGREEMENT FOR PREARRANGED PAYMENTS (DEBITS)

    This is my authorization to Love’s Family of Companies (Love’s Travel Stops & Country Stores, Inc.,
    Musket Corporation, Gemini Motor Transport L.P., or Trillium Transportation Fuels, LLC) to
    automatically debit my account as listed below:

    Transit/ABA #:________________________________ Account #: _____________________________

    Bank Name: _________________________________ City, State______________________________

    AFFIX VOIDED CHECK HERE

    I UNDERSTAND THAT THIS AUTHORIZATION WILL BE IN EFFECT UNTIL I NOTIFY MY FINANCIAL


    INSTITUTION IN WRITING THAT I NO LONGER DESIRE THIS SERVICE, ALLOWING IT REASONABLE TIME TO
    ACT ON MY NOTIFICATION.

    I HAVE THE RIGHT TO STOP PAYMENT OF A DEBIT ENTRY BY NOTIFYING MY FINANCIAL INSTITUTION
    BEFORE ACCOUNT IS CHARGED.

    Business Name/Account Number Authorized Signature

    Date Printed Name & Title

    FAX COMPLETED FORM TO: 405-463-3954


    OR
    EMAIL TO: [email protected]
    INSTRUCTIONS ON HOW TO COMPLETE THIS AGREEMENT

    Transit/ABA # Account # Check #


    (9 Digits) (Do Not Include)

    FAX COMPLETED FORM TO: 405-463-3954


    OR
    EMAIL TO: [email protected]

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