Bank Draft Authorization
If same as Service Address, please enter "n/a"
A copy of your voided check/deposit slip is REQUIRED and may be uploaded here, emailed to firstname.lastname@example.org, or submitted in person. We must receive a copy of your voided check/deposit slip BEFORE an ACH Bank Draft is started.
Please check each box to acknowledge that you have read the Terms and Conditions.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
This field is not part of the form submission.
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