9436 RUSH STREET 10323 HARRY HINES BLVD.
SOUTH EL MONTE, CA 91733 DALLAS, TX 75220
TEL: 626-228-0251 TEL: 214-366-1328
FAX: 626-228-0253 FAX: 214-956-8882
Maxtradesales@sbcglobal.net Sales@Coolster.com
 
 

ACH Payment Authorization Form

ACH is a direct payment method that you or your company authorizes us to automatically deduct from your checking or saving account for the invoice or invoices.
The authority you or your company give to charge your account will remain in effect until you or your company notify us in writing to terminate the authorization.

You need to do the following:

1) Mark the box before type of account to indicate whether your or your company’s checking or savings account.
2) Fill in you and your company's name, financial institution name and location, and date.
3) Attach a voided check for verification of financial institution information.

Please Complete the information below.

I authorize MAXTRADE LLC to initiate electronic debit entries to my or our company’s:

Checking account (or) Savings account


For payment of my or our invoice or invoices.

I acknowledge that the origination of ACH transactions to my or our account must comply with the provisions of U.S laws. This authority will remain in effect until I have cancelled it in writing.

FINANCIAL INSTITUTION NAME (PLEASE PRINT)

ACCOUNT NUMBER AT FINANCIAL INSTITUTION

FINANCIAL INSTITUTION ROUTING NUMBER

FINANCIAL INSTITUTION CITY AND STATE

YOUR COMPANY’S NAME

PRINT YOUR NAME TITTLE

AUTHORIZED SIGNATURE DATE