DirectDepositAuthorization

    I authorize Hometown Holdings, LLC to initiate credit entries, as well as appropriate adjustments and debit entries to correct errors, to the account indicated below. I acknowledge that the origination of ACH (electronic deposit) transactions to my account must comply with the provisions of U.S. law.

    Account Information:

    *Account Type

    *Institution Name

    *Bank Routing# / ABA#

    *Account Number

    *Entity or Entities included under this account

    This authorization is to remain in full force and effect until Hometown Holdings , LLC has received written notification from me of its termination, or until I no longer have a business relationship with Hometown Holdings, LLC.

    By checking this box and filling out the full name, eMail, and date fields, I am digitally signing this Authorization form and giving Hometown Holdings, LLC the above permissions. (note: a copy of the completed/digitally signed form will also be sent to the email given below.)

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