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 ---CheckingSavings
*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.)
*Owner's Full Name
*Owner's eMail
*Today's Date