ACH/EFT Authorization Form by GoPkbJ


									                                             Electronic Funds Transfer                      Marriott Business Services
                                                 Authorization for                             1965 Marriott Drive
                                                                                              Louisville, TN 37777
                                              Payments Made by MBS

“Payee Name” hereby (1) authorizes Marriott Business Services to make payment by EFT, (2) certifies that it has
selected the following depository institution, and (3) direct that all such Electronic Funds Transfers be made as
provided below:

Property Information:

Property Name:                                                                           Date:

Business Unit:                                                        Business Location:

Depository Bank Information:
We would like our disbursements paid via EFT and deposited into the following bank account:

Account Type:         Checking                  Savings     Other - Please Describe


   Bank Name:                                                                Currency Code:

Bank Address:
                                        Street Address                                  City, State, and Zip
 Bank Routing                                                    Bank Account
     Number:                                                         Number:

 “Payee Name”
   on Account:

International Bank Information:

SWIFT/SORT Code:                                           Bank Branch Name:

Requestor’s Contact Information:

Contact Name:

Email Address:                                                             Phone Number:

Terms and Conditions:
“Payee Name” is required to give Marriott Business Services thirty (30) days advance notice in writing of any changes in
the above banking information or any other payment instructions. All set-ups, changes, and/or modifications require a
copy of a voided check and/or bank letter that includes specification sheet.

                        Signature of Payee                                                  Date

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