EFT Authorization

    Electronic Funds Transfer Preauthorization for Account #

    The undersigned authorizes L. J. Zucca, Inc. to originate debit entries (drafts) by EFT from their bank account indicated below. And, the undersigned authorizes the Depository Institution named below (the bank) to accept and to debit the amount of such entries from their account and transfer funds to L. J. Zucca, Inc.

    Authorization

    Customer name (AS SHOWN ON BANK ACCOUNT):
    Address:
    City:
    State:
    Zip:
    Phone number:
    Fax number:
    E-mail address:
    Authorized Signature:
    Title:
    Date:
    Contact Name:
    Title:
    Phone (if different from above):

    Debit entries (drafts) will only be honored if sufficient funds are available in the pre-designated account. Cancellations of this authority must be received by written notification 30 days prior to termination date.

    Bank Information

    BANK name:
    Branch:
    Bank Address:
    City:
    State:
    Zip:
    Bank Phone number:
    Contact:
    Bank account number:
    Bank ABA number (First 9 digits at the bottom left corner of your check):
    Please attach a voided check for the bank account from which this EFT payments will be debited.