AUTHORIZATION AGREEMENT FOR AUTOMATIC (ACH) DEBIT


Name:  

Company:  

Address:  

City: State: ZIP:  

Contact Email: Phone:  

I (we) hereby authorize Texas Precious Metals, hereinafter called TPM, to initiate debit entries (pre- authorized drafts or withdrawals) and to initiate, if necessary, credit entries and adjustments for credit entries in error to my (our) CHECKING ACCOUNT indicated below at the Bank named below, to credit and/or debit the same to such account. I (we) also hereby authorize TPM to verify any or all of the information listed on this form with the bank contact listed below.

Bank Name:

Branch Address:

City: State: ZIP:  

Bank Contact: Contact # 

Routing/ABA No. Account No. 

TPM will debit the full amount of my purchase on or after the date of this notification. This authority is to remain in full force and effect until funds have been received by TPM, the termination of this agreement will be agreed upon via other communications (i.e.: email, written letter, etc).

*** NOTE: WE REQUIRE A COPY OF YOUR DRIVER’S LICENSE WITH THIS FORM.  UPLOAD COPY HERE *** 

 

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Signature Certificate
Document name: AUTHORIZATION AGREEMENT FOR AUTOMATIC (ACH) DEBIT
lock iconUnique Document ID: 02e92289875824ad2503ea16c9553832b11f9633
Timestamp Audit
April 3, 2020 12:55 pm CDTAUTHORIZATION AGREEMENT FOR AUTOMATIC (ACH) DEBIT Uploaded by Tarek Saab , President - storage@texasdepository.com IP 216.82.142.58
April 3, 2020 2:34 pm CDTNotices Depository - notices@texasdepository.com added by Tarek Saab , President - storage@texasdepository.com as a CC'd Recipient Ip: 216.82.155.148
April 3, 2020 3:29 pm CDTNotices Depository - notices@texasdepository.com added by Tarek Saab , President - storage@texasdepository.com as a CC'd Recipient Ip: 216.82.155.148
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