Automatic Account Debiting


If you would like for your monthly association dues to be automatically debited from an account, please fill out the form below. Submissions must be received at least five business days prior to the beginning of any given month in order for debits to begin in that month. Automatic debits are processed on the fifth of the month or the following business day.

Full Name
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Mailing Address
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City
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State
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Zip Code
*
Contact Number
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E-Mail Address

Association Name
*
Unit Number(s) to be Debited
*

Select One
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Depository Financial Institution
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City
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State
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Zip Code
*
Transit Routing Number
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Account Number
*
This is a
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Month to Begin Debiting
select
Please attached an image of a voided check for account validation.
*

I (We) herby authorize the Association listed above, hereinafter called COMPANY, to initiate debit entries and to facilitate, if necessary, credit entries and adjustments for any debit entries in error to my (our) account indicated below and the depository financial institution named above, hereinafter called DEPOSITORY, to debit and/or credit the same in such account.

This authority is to remain in full force and in effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.  Please attach a voided check for account validation.

By checking the box below, I am authorizing the COMPANY above to begin automatically debiting the account listed above.  I understand that in order to cancel this service, I must contact Parker & Associates.  Automatic debiting shall continue until notice is given.