Authorization Agreement for Automatic Debits - Grosse Ile Municipal Airport

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEBITS (ACH DEBITS)

I authorize the Grosse Ile Municipal Airport, hereinafter referred to as the Company, to make preauthorized withdrawals on or shortly after the fifteenth day of the month from the following account: Account Depository Financial Institution (DFI):

Routing and Transit Number of DFI:

Account Number:

Account Type:

Checking

Savings

The monthly transfer for rental payments is subject to change in accordance with Lease Agreements and Grosse Ile Airport Commission Policy. I authorize the Depository Financial Institution listed above to accept these withdrawals. I also understand that adjusting entries may be made to correct any errors in the withdrawals. It is agreed that these withdrawals and adjustments may be made electronically and are bound by the rules of the Michigan Clearing House Association. This authorization is to remain in effect until I provide a written notice of termination to the Company. I agree to the following monthly transfer amount:

Message:

Address:

Digital Signature

Today's Date:

PLEASE ATTACH A VOIDED CHECK OR DEPOSIT TICKET WITH THIS FORM.

click here to add a photo of a voided check for verification

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEBITS (ACH DEBITS)

Have questions about our facilities?

Contact

Address

9601 Groh Road
Grosse Ile, MI 48138

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEBITS (ACH DEBITS)

Have questions about our facilities?

Contact

Address

9601 Groh RoadGrosse Ile, MI 48138

9601 Groh Road
Grosse Ile, MI 48138