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Resident Authorization for Recurring Direct Debit

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Resident Authorization for Recurring Direct Debit Powered By Docstoc
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         THERE IS NO CHARGE FOR THIS SERVICE
ACH DEBIT AUTHORIZATION FORM – Trike Property Management
        Resident Authorization for Recurring Direct Debit
   1.   Complete the Resident Address Section.
                                                              Property Manager Name
   2.   Complete the Bank account Information.
   3.   Read and Sign the Authorization portion.
   4.   Retain a copy of this form for your records.
   5.   Fax or mail the original along with a copy of a voided check from the account
        the debit will be made. Fax Number: 414-332-5511
           Resident Information             Trike Property Management Information
Name:____________________________________                Trike Property Management
Address:__________________________________                     P.O. Box 11159
Apt No.:__________________________________                 Milwaukee, WI 53211
City:_____________________________________
                                                            Phone: 414-332-5500
                                                             Fax: 414-332-5511
State:_____________________________________
                                                          maskotzky@trikpm.com
Zip:______________________________________
                                                             www.trikepm.com
Phone:____________________________________

E-Mail:___________________________________

                                    Bank Account Information
I would like the monthly rental amount to be debited from the following account:
Account Type:  Checking           Savings        Debit
Bank Name:
Account Holder’s Name:
Account Number:
Routing Number:
Recurring Debit Start Date: Month:____________________
                              Day:      1st     2nd      3rd Note: Please attach a voided check and
                                             Circle One         return with this form.

                                     $                          Signature:__________________________
                    Rent Amount:
Credits to be applied to 1st payment if any:                    Date:______________________________
                                               $
                                             Authorization
I (we, if joint account) hereby authorize Trike Property Management (processor) to initiate credit/debit
entries to my (our) Checking or Savings account at the financial institution as indicated above. I (we)
acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions
of the United State law. If I (we) do not have enough money in my (our) funding account to cover the
transfer or if my (our) Financial Institution for any other reason refuses to honor a transfer, I (we) will
separately pay Trike Property Management for the charges I (we) owe under this service contract.

FEE NOTICE: I (we) acknowledge and agree to a service charge that will be added to each transaction.
Furthermore, I (we) acknowledge and agree to a $ 30.00 Non Sufficient Fund charge, should there not be
enough money in the funding account and the ACH charge is declined and / or returned.

This authorization is for the recurring monthly debit of the rental amount and service charge as indicated
above, and is to remain in full force and effective until we have received written notification from you (or
us) of its termination in such time and in such manner as to afford the Financial Institution and us a
reasonable opportunity to act on it. We deem this to be seven (7) days. You may cancel this agreement at
any time by faxing (414-332-5511) or mailing a written request to our leasing office.
Trike Property Management reserves the right to cancel this agreement at any time.

				
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posted:4/8/2011
language:English
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